Abstract
Background:
Pediatric venous thromboembolism (VTE) is an increasingly common, difficult to diagnose problem. Clinical probability tools (CPT) for adults estimate VTE likelihood, but are not available for children. We hypothesized that a pediatric-specific CPT is feasible.
Methods:
Radiology reports were utilized to identify children imaged for suspected VTE. Relevant signs, symptoms, and comorbidity variables, identified from published literature, were extracted from corresponding medical records. Variables associated with pediatric VTE were incorporated into a multivariate logistic regression to create a pilot CPT which was confirmed on a separate cohort.
Results:
A total of 389 subjects meeting inclusion criteria were identified: 91 with VTE and 298 without. Univariate analysis revealed male gender (odds ratio (OR) = 2.96; P < 0.001), asymmetric extremity (OR = 1.76; P = 0.033), central venous catheter utilization and/or dysfunction (OR = 2.51; P < 0.001), and cancer (OR = 2.35; P = 0.014) as VTE predictive variables. Documentation of an alternate diagnosis was inversely related to VTE (OR = 0.42; P = 0.004). Receiver operating characteristic analysis of the derived CPT demonstrated reasonable ability to discriminate VTE probability in the training cohort (area under the curve (AUC) = 0.73; P < 0.001) and moderate discrimination in a separate validation cohort of 149 children (AUC = 0.64; P = 0.011).
Conclusion:
A pediatric-specific VTE CPT is feasible, would facilitate early diagnosis, and could lead to improved outcomes.
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Acknowledgements
The authors are indebted to Dawn Fowler for performing the radiology records keyword searches as well as Marlene Wears, Corinna Bowers, and Susan Cunningham for diligently executing the chart abstractions. The funding sources played no role in the collection, analysis, interpretation, or publication decisions. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.
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Kerlin, B., Stephens, J., Hogan, M. et al. Development of a pediatric-specific clinical probability tool for diagnosis of venous thromboembolism: a feasibility study. Pediatr Res 77, 463–471 (2015). https://doi.org/10.1038/pr.2014.198
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DOI: https://doi.org/10.1038/pr.2014.198
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