Pulmonary embolism: which pediatric trauma patients are at risk?

Background/Purpose: Deep vein thrombosis and pulmonary embolism (DVT/PE) are rare in pediatric trauma patients, and guidelines for prophylaxis are scarce. The authors sought to identify subgroups of patients who may be at higher risk of developing DVT/PE. Methods: Case-control study of pediatric trauma patients with DVT/PE. Odds ratios (ORs) and confidence intervals (CIs) were calculated for known risk factors of PE using matched trauma controls (X-2 analysis). Results: A total of 3637 pediatric trauma patients was admitted over the last 7 years. Three patients developed DVT/PE (overall incidence, 0.08%). There were 2 girls and 1 boy, aged 15, 15, and 9 years, respectively. All 3 had an Injury Severity Score (ISS) 25 and an initial Glasgow Coma Score (GCS) less than or equal to8. None of the known and potential risk factors significantly increased the OR for developing DVT/PE: age 9 years or older (OR, 3.6; CI, 0.4-26), presence of head injury (OR, 2.9; CI, 0.3-22), female sex (OR, 1.2; CI, 0.15-9.1), GCS less than or equal to8 (OR, 9.2; CI, 0.9-230), except ISS greater than or equal to25 (OR, 82; CI, 7.6-2058). The OR for a combination of age and GCS was 106, and the OR for the 3 risk factors (age, ISS, GCS) common to all 3 patients was 114 (CI, 10-5000; P < .001). Conclusions: The overall incidence of DVT/PE in pediatric trauma patients is < 0.1% and routine prophylaxis is not recommended. Children aged 9 years or older with an initial GCS less than or equal to8 and patients with an estimated ISS greater than or equal to25 may constitute a high-risk group in which prophylaxis could be considered. (C) 2005 Elsevier Inc. All rights reserved.