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Purpose of Review <p>The review aims to delineate the risk factors for venous thromboembolism (VTE) in the pediatric trauma population and provide an overview of the current evidence on the role of screening and prophylaxis.</p> Recent Findings <p>In recent years, there has been a substantial increase in literature on identifying risk factors, screening methods, and preventive strategies for VTE in pediatric trauma patients. Studies have identified various risk factors including the presence of central venous catheters (CVCs), age, injury severity score (ISS), Glasgow Coma Scale (GCS) score, mechanical ventilation, nature of injury, major surgery, and comorbidities. Novel risk assessment tools have been developed based on these risk factors to assist in the selection of appropriate candidates for chemical or mechanical prophylaxis. Thromboprophylaxis is often recommended in cases of high VTE risk with low bleeding risk. However, the utility of surveillance ultrasounds remains controversial, with protocols utilizing ultrasound screening detecting higher rates of deep venous thrombosis (DVT) than previously reported. Yet, the longitudinal course of asymptomatic DVTs in children remains poorly understood due to their rarity. Studies investigating the optimal type, duration and timing of prophylaxis have shown promise for low molecular weight heparin (LMWH) in reducing VTE risk in high-risk pediatric trauma patients, although data on duration and timing is less robust. While mechanical prophylaxis is commonly recommended, its benefits are not definitively established.</p> Summary <p>The expanding data on pediatric VTE underscores significant variability in the management and gaps in knowledge. While various risk stratification tools are available, further investigation is needed to weigh the benefits against risks of chemical prophylaxis, particularly regarding timing and duration. Additionally, the efficacy of mechanical prophylaxis remains unclear. Future studies should also explore the effectiveness of novel oral anticoagulants in pediatric trauma patients.</p>

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Venous Thromboembolism in Pediatric Trauma: Risk Factors, Screening, and Prevention

  • 期刊论文

  • 发表日期：

    2025年5月26日

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  • Leigh Selesner,
  • Mubeen Jafri,
  • Lucas A. McDuffie

摘要

Purpose of Review

The review aims to delineate the risk factors for venous thromboembolism (VTE) in the pediatric trauma population and provide an overview of the current evidence on the role of screening and prophylaxis.

Recent Findings

In recent years, there has been a substantial increase in literature on identifying risk factors, screening methods, and preventive strategies for VTE in pediatric trauma patients. Studies have identified various risk factors including the presence of central venous catheters (CVCs), age, injury severity score (ISS), Glasgow Coma Scale (GCS) score, mechanical ventilation, nature of injury, major surgery, and comorbidities. Novel risk assessment tools have been developed based on these risk factors to assist in the selection of appropriate candidates for chemical or mechanical prophylaxis. Thromboprophylaxis is often recommended in cases of high VTE risk with low bleeding risk. However, the utility of surveillance ultrasounds remains controversial, with protocols utilizing ultrasound screening detecting higher rates of deep venous thrombosis (DVT) than previously reported. Yet, the longitudinal course of asymptomatic DVTs in children remains poorly understood due to their rarity. Studies investigating the optimal type, duration and timing of prophylaxis have shown promise for low molecular weight heparin (LMWH) in reducing VTE risk in high-risk pediatric trauma patients, although data on duration and timing is less robust. While mechanical prophylaxis is commonly recommended, its benefits are not definitively established.

Summary

The expanding data on pediatric VTE underscores significant variability in the management and gaps in knowledge. While various risk stratification tools are available, further investigation is needed to weigh the benefits against risks of chemical prophylaxis, particularly regarding timing and duration. Additionally, the efficacy of mechanical prophylaxis remains unclear. Future studies should also explore the effectiveness of novel oral anticoagulants in pediatric trauma patients.