重症青少年的机械性血栓预防和医院获得性静脉血栓栓塞症:2016-2023年美国儿科健康信息系统注册研究》。

IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pediatric Critical Care Medicine Pub Date : 2024-08-20 DOI:10.1097/PCC.0000000000003601
Marisol Betensky, Nikhil Vallabhaneni, Neil A Goldenberg, Anthony A Sochet
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引用次数: 0

摘要

目的利用多中心管理数据库估算重症青少年的机械性血栓预防(mTP)处方率,并确定mTP处方是否与医院获得性静脉血栓栓塞成反比:多中心、观察性、回顾性儿科健康信息系统(PHIS)注册队列研究,2016年1月至2023年12月:美国四级儿科转诊中心内的 30 个 PICU:干预措施:住院后 24 小时内开具 mTP 处方:共有 107,804 名儿童符合研究标准,其中 21,124 人(19.6%)获得了 mTP 处方。医院中心处方率从1.4%到65.4%不等,每年下降1.6%,从2016年的28.2%降至2023年的17.1%。与未使用 mTP 的患者相比,使用 mTP 的患者更常同时使用中心静脉导管(17.2% vs. 9.4%,p < 0.001)、进行有创机械通气(37.4% vs. 24.8%,p < 0.001),因主要手术指征入院(30.9% vs. 12.7%,P < 0.001),住院时间中位数更长(7 [四分位距(IQR):4-15] d vs. 4 [四分位距(IQR):2-9] d,P < 0.001)。在研究样本中,2.7%的患者发生了医院获得性静脉血栓栓塞,与未处方 mTP 的患者相比,处方 mTP 的患者发生静脉血栓栓塞的比例更高(4% 对 2.4%,P < 0.001)。在医院获得性静脉血栓栓塞症的多变量逻辑回归模型中,在调整了显著的血栓前危险因素后,我们未能在低、中、高风险层级中发现 mTP 与更高的医院获得性静脉血栓栓塞症(HA-VTE)发生几率之间存在关联。然而,我们不能排除在这一人群中发生 HA-VTE 的几率比正常人高出 17%-50% 的可能性:在2016-2023年多中心PHIS队列中,重症青少年的mTP处方模式显示,mTP处方率较低(19.6%),各机构间差异较大,在研究期间每年下降1.6%,且与HA-VTE风险降低无独立关联。
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Mechanical Thromboprophylaxis and Hospital-Acquired Venous Thromboembolism Among Critically Ill Adolescents: A U.S. Pediatric Health Information Systems Registry Study, 2016-2023.

Objectives: To estimate the rate of mechanical thromboprophylaxis (mTP) prescription among critically ill adolescents using a multicenter administrative database and determine whether mTP prescription is inversely associated with hospital-acquired venous thromboembolism.

Design: Multicenter, observational, retrospective study of the Pediatric Health Information Systems (PHIS) Registry cohort, January 2016 to December 2023.

Setting: Thirty PICUs located within quaternary pediatric referral centers in the United States.

Patients: Critically ill children 12-17 years old, excluding encounters with a principal diagnosis at admission of venous thromboembolism.

Interventions: mTP prescription within the first 24 hours of hospitalization.

Measurements and main results: A total of 107,804 children met the study criteria, of which 21,124 (19.6%) were prescribed mTP. Hospital center prescribing rates ranged from 1.4% to 65.4% and decreased by 1.6% per year from 28.2% in 2016 to 17.1% in 2023. As compared with those without mTP, those with mTP more frequently had a concurrent central venous catheter (17.2% vs. 9.4%, p < 0.001), underwent invasive mechanical ventilation (37.4% vs. 24.8%, p < 0.001), were admitted for a primary surgical indication (30.9% vs. 12.7%, p < 0.001), and experienced a longer median duration of hospitalization (7 [interquartile range (IQR): 4-15] vs. 4 [IQR: 2-9] d, p < 0.001). Hospital-acquired venous thromboembolism occurred in 2.7% of the study sample and was more common among those with, as compared with without, prescription of mTP (4% vs. 2.4%, p < 0.001). In multivariable logistic regression models for hospital-acquired venous thromboembolism adjusting for salient prothrombotic risk factors, we failed to identify an association between mTP and greater odds of hospital-acquired venous thromboembolism (HA-VTE) among low-, moderate-, and high-risk tiers. However, we cannot exclude the possibility of 17-50% greater odds of HA-VTE in this population.

Conclusions: In the multicenter PHIS cohort, 2016-2023, the prescribing patterns for mTP among critically ill adolescents showed a low rate of mTP prescription (19.6%) that varied widely across institutions, decreased annually over the study period by 1.6%/year, and was not independently associated with HA-VTE risk reduction.

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来源期刊
Pediatric Critical Care Medicine
Pediatric Critical Care Medicine 医学-危重病医学
CiteScore
7.40
自引率
14.60%
发文量
991
审稿时长
3-8 weeks
期刊介绍: Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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