目的:美国小儿外科协会结果和循证实践委员会进行了系统评价,以描述小儿外科和创伤患者静脉血栓栓塞(VTE)的流行病学,并提出筛查和预防建议。
方法:Medline(Ovid),Embase,科克伦,从2000年1月到2021年12月查询了WebofScience数据库。搜索词涉及以下主题:发生率,超声筛查,机械和药物预防。遵循系统评价和荟萃分析(PRISMA)指南的首选报告项目。共识建议是根据现有的最佳文献得出的。
结果:纳入了一百二十四项研究。小儿手术人群中VTE的发生率为0.29%(范围=0.1%-0.48%),与手术类型直接相关。输血,长时间麻醉,恶性肿瘤,先天性心脏病,炎症性肠病,感染,和女性性。小儿创伤人群中VTE的发生率为0.25%(范围=0.1%-0.8%),与创伤严重程度直接相关。大手术,中心线位置,身体质量指数,脊髓损伤,和停留时间。不建议常规超声筛查VTE。考虑在有风险的非移动设备中使用顺序压缩设备,儿科手术患者,当一个适当的大小的设备是可用的。在青少年>15岁和青春期<15岁且损伤严重程度评分>25的儿童中,考虑单独进行机械预防或进行药物预防。当使用药物预防时,低分子量肝素优于普通肝素。
结论:虽然VTE在儿童中仍然是罕见的并发症,在某些人群中,考虑机械和药物预防是适当的。
方法:2-4级研究的系统评价。
方法:3-4级。
OBJECTIVE: The American
Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee conducted a systematic review to describe the epidemiology of venous thromboembolism (VTE) in
pediatric surgical and trauma patients and develop recommendations for screening and prophylaxis.
METHODS: The Medline (Ovid), Embase, Cochrane, and Web of Science databases were queried from January 2000 through December 2021. Search terms addressed the following topics: incidence, ultrasound screening, and mechanical and pharmacologic prophylaxis. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Consensus recommendations were derived based on the best available literature.
RESULTS: One hundred twenty-four studies were included. The incidence of VTE in
pediatric surgical populations is 0.29% (Range = 0.1%-0.48%) and directly correlates with surgery type, transfusion, prolonged anesthesia, malignancy, congenital heart disease, inflammatory bowel disease, infection, and female sex. The incidence of VTE in
pediatric trauma populations is 0.25% (Range = 0.1%-0.8%) and directly correlates with injury severity, major surgery, central line placement, body mass index, spinal cord injury, and length-of-stay. Routine ultrasound screening for VTE is not recommended. Consider sequential compression devices in at-risk nonmobile,
pediatric surgical patients when an appropriate sized device is available. Consider mechanical prophylaxis alone or with pharmacologic prophylaxis in adolescents >15 y and post-pubertal children <15 y with injury severity scores >25. When utilizing pharmacologic prophylaxis, low molecular weight heparin is superior to unfractionated heparin.
CONCLUSIONS: While VTE remains an infrequent complication in children, consideration of mechanical and pharmacologic prophylaxis is appropriate in certain populations.
METHODS: Systematic Review of level 2-4 studies.
METHODS: Level 3-4.