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Abstract：
Local pediatric screening guidelines for venous thromboembolism (VTE) are developed from incomplete pediatric data and extrapolated from adult data in which immobility is a major risk factor. We hypothesized that screening guidelines centered on immobility are inadequate for identifying children at risk of central venous catheter (CVC)-associated VTE.
This retrospective case-control (4:1) study at an academic, quaternary-level, free-standing children\'s hospital applied screening guidelines for VTE risk to all cases of VTE from July 2012 to April 2014. Cases and controls were classified as \"at risk\" or \"not at risk\" of VTE by guideline criteria. These guidelines assessed VTE risk factors, including CVC, as reported in the pediatric literature.
VTE prevalence was 0.5 per 100 admissions. Sixty-nine of 114 patients with radiographically confirmed VTE were classified as being \"at risk\" by the guidelines, with a sensitivity of 61%, specificity of 90.8%, a positive predictive value of 2.4%, and negative predictive value of 99.8%. There was no difference in screening guidelines sensitivity for identifying CVC-associated VTE versus non-CVC-associated VTE. Half of the 45 patients with VTE who were not captured as being \"at risk\" did not have decreased mobility, the entry point to the algorithm, and 80% of these patients had a CVC.
Screening guidelines have low sensitivity for identifying hospitalized children at increased risk of both CVC-associated and other VTE events. Decreased mobility is not a requirement for CVC-associated VTE. Risk factors extrapolated from adult data are insufficient for identifying children at risk of VTE.
This retrospective case-control (4:1) study at an academic, quaternary-level, free-standing children\'s hospital applied screening guidelines for VTE risk to all cases of VTE from July 2012 to April 2014. Cases and controls were classified as \"at risk\" or \"not at risk\" of VTE by guideline criteria. These guidelines assessed VTE risk factors, including CVC, as reported in the pediatric literature.
VTE prevalence was 0.5 per 100 admissions. Sixty-nine of 114 patients with radiographically confirmed VTE were classified as being \"at risk\" by the guidelines, with a sensitivity of 61%, specificity of 90.8%, a positive predictive value of 2.4%, and negative predictive value of 99.8%. There was no difference in screening guidelines sensitivity for identifying CVC-associated VTE versus non-CVC-associated VTE. Half of the 45 patients with VTE who were not captured as being \"at risk\" did not have decreased mobility, the entry point to the algorithm, and 80% of these patients had a CVC.
Screening guidelines have low sensitivity for identifying hospitalized children at increased risk of both CVC-associated and other VTE events. Decreased mobility is not a requirement for CVC-associated VTE. Risk factors extrapolated from adult data are insufficient for identifying children at risk of VTE.
摘要：
静脉血栓栓塞症（VTE）的当地儿科筛查指南是从不完整的儿科数据中制定的，并从成年数据中推断出来，其中固定是主要的危险因素。我们假设以不活动为中心的筛查指南不足以识别有中心静脉导管（CVC）相关VTE风险的儿童。
这项回顾性病例对照(4:1)研究在一项学术研究中，第四纪，2012年7月至2014年4月,独立儿童医院对所有VTE病例应用了VTE风险筛查指南.根据指南标准，病例和对照被分类为“有危险”或“无危险”。这些指南评估了VTE的危险因素，包括CVC,正如儿科文献报道的那样。
VTE患病率为每100例入院0.5例。114例经放射学证实的VTE患者中有69例被指南归类为“有风险”，灵敏度为61%，特异性90.8%，2.4%的阳性预测值，阴性预测值为99.8%。筛选指南对CVC相关VTE与非CVC相关VTE的敏感性无差异。45例未被捕获为“处于危险中”的VTE患者中，有一半没有活动能力下降，算法的入口点，这些患者中有80％患有CVC。
筛查指南对于确定CVC相关和其他VTE事件风险增加的住院儿童的敏感性较低。降低的移动性不是CVC关联的VTE的要求。从成人数据推断的危险因素不足以识别有VTE风险的儿童。
这项回顾性病例对照(4:1)研究在一项学术研究中，第四纪，2012年7月至2014年4月,独立儿童医院对所有VTE病例应用了VTE风险筛查指南.根据指南标准，病例和对照被分类为“有危险”或“无危险”。这些指南评估了VTE的危险因素，包括CVC,正如儿科文献报道的那样。
VTE患病率为每100例入院0.5例。114例经放射学证实的VTE患者中有69例被指南归类为“有风险”，灵敏度为61%，特异性90.8%，2.4%的阳性预测值，阴性预测值为99.8%。筛选指南对CVC相关VTE与非CVC相关VTE的敏感性无差异。45例未被捕获为“处于危险中”的VTE患者中，有一半没有活动能力下降，算法的入口点，这些患者中有80％患有CVC。
筛查指南对于确定CVC相关和其他VTE事件风险增加的住院儿童的敏感性较低。降低的移动性不是CVC关联的VTE的要求。从成人数据推断的危险因素不足以识别有VTE风险的儿童。
