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Key Findings: Trends in Venous Thromboembolism-Related Pediatric Hospitalizations, 1994-2009

Kids huddling in a circleRecently, researchers used data from the 1994-2009 Nationwide Inpatient Sample (NIS), a national database of hospital discharges, to describe trends in VTE-associated pediatric hospitalizations in the U.S. and to evaluate changes in selected factors associated with pediatric VTE. The results were published in Pediatrics. You can read the abstract here. The key findings from this article are summarized in the following text.

VTE — the presence of blood clot(s) in the deep veins, usually in a leg or the pelvis--deep vein thrombosis (DVT) or the lungs--pulmonary embolism (PE). PE occurs when a clot in a deep vein breaks up (or embolizes) and clots break free and pass through the right side of the heart into the arteries of the lungs. In children, VTE is often a complication of treatment for other chronic conditions and is associated with significant illness and death.1,2,3

Main findings from this study:

  • Data from the study showed that there has been a significant increase in the frequency of hospitalizations with VTE diagnoses recorded among U.S. children between 1994 and 2009. The largest increases in VTE diagnoses were noted among children <1 year of age and those 12—17 years of age.
  • During 1994-2009, an estimated 78,685 (0.14%) pediatric discharges had a VTE diagnosis recorded, of which 3740 were associated with in-hospital death.
  • The degree to which increased awareness of VTE influenced the increase in diagnoses could not be determined in this study. However, other studies indicate that a major explanation for similar increases in adult VTE diagnoses is the dramatic increase in the use of imaging tests to diagnose VTE.
  • It is not known how much of the increase in pediatric VTE diagnoses is due to an actual increase in the occurrence of VTE in hospitalized children and how much is due to increases in clinical recognition and reporting.
  • Increases in the frequency of venous catheter procedures were observed and may have contributed to the observed increase in the frequency of VTE diagnoses among pediatric hospitalizations.

CDC Activities

VTE is associated with substantial illness and death, primarily in adults. Estimates of the annual incidence of VTE in children range from 0.7 to 2.1 per 100,000.1,4,5 Health care costs incurred by the average (median) child with VTE approximate $25,000 per year.6

Preventing VTE is a national priority and supports Healthy People 2020 objectives. In 2008, the Surgeon General released a Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. CDC is committed to working with its partners and the public to address VTE public health needs through the development and strengthening of surveillance, research, health promotion and education, and laboratory capacity.

  • Surveillance: CDC is developing population-based surveillance pilot systems to provide information on VTE occurring in the community (both inpatient and outpatient). CDC is also planning to develop a VTE component within CDC’s National Healthcare Safety Network (NHSN) to conduct hospital surveillance of VTE and assess use of prevention strategies within hospitals.
  • Health Promotion and Education: CDC works with partners to develop and disseminate educational and awareness materials for the general public, patients in high risk settings, and healthcare providers about risk factors, prevention opportunities, and signs and symptoms of VTE. Examples include the National Blood Clot Alliance sponsored Stop the Clot patient forums and healthcare curriculum (http://www.stoptheclot.org) and the Vascular Disease Foundation’s This is Serious awareness campaign for women at risk for VTE.
  • Collaboration: CDC works with stakeholders to inform, promote, and guide activities around VTE surveillance and the prevention of hospital-associated VTE, promote use of evidence-based guidelines, and promote VTE prevention across the healthcare system.

More Information

To learn more about VTE, please visit http://www.cdc.gov/ncbddd/dvt/index.html. For more information about blood disorders, please visit http://www.cdc.gov/ncbddd/blooddisorders/index.html.

References

  1. Andrew M, David M, Ali K, Anderson R, Barnard D, et al. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood. 1994;83:1251-1257.
  2. Monagle P, Adams M, Mahoney M, Ali K, Barnard D, Bernstein M, et al. Outcome of pediatric thromboembolic disease: a report from the Canadian Childhood Thrombophilia Registry. Pediatr Res. 2000;47:763-766.
  3. Chalmers EA. Epidemiology of venous thromboembolism in neonates and children. Thromb Res. 2006;118:3-12.
  4. van Ommen CH, Heijboer H, Buller HR, Hirasing RA, Heijmans HS, Peters M. Venous thromboembolism in childhood: a prospective two-year registry in The Netherlands. J Pediatr. 2001;139:676-681.
  5. Tuckuviene R, Christensen AL, Helgestad J, Johnsen SP, Kristensen SR. Pediatric venous and arterial noncerebral thromboembolism in Denmark: a nationwide population-based study. J Pediatr. 2011;159:663-669.
  6. Boulet SL, Amendah D, Grosse SD, Hooper WC. Health care expenditures associated with venous thromboembolism among children. Thromb Res. 2012;129:583-7.

Reference for Key Findings Feature:

Boulet SL, Grosse SD, Thornburg CD, Yusuf H, Tsai J, Hooper WC. Trends in Venous Thromboembolism-Related Hospitalizations, 1994-2009. Pediatrics. 2012; 130(4):e812-e820.

 
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