Abstract Number: PB1281
Meeting: ISTH 2020 Congress
Background: Venous thromboembolic events (VTE) pose a significant challenge in pediatric orthopedic surgical patients (POSP). Since universal thromboprophylaxis is not recommended, there is a need for a validated screening tool to identify high-risk patients and optimize thromboprophylaxis. A VTE thromboprophylaxis screening tool for POSP was developed and implemented at the IWK Health Centre in October 2016 (Figure 1).
Aims: To evaluate the impact of the VTE thromboprophylaxis screening tool on use of thromboprophylaxis and VTE in POSP.
Methods: This study (duration: December 1, 2014 to June 1, 2019) was approved research ethics board. Using the tool, all POSPs were screened, scored, and categorized into low, moderate, and high risk groups. Pharmacological thromboprophylaxis was recommended in high risk patients (risk score >4) in consultation with pediatric hematology. Thromboprophylaxis use and VTE were the primary study outcomes. Cases (all patients post implementation of screening tool) and controls (all patients pre implementation of screening tool) were compared.
Results: The VTE thromboprophylaxis screening tool was used in 62.6% (n=411) of the 657 POSPs since October 2016. Of the 684 control patients, 28 (4.1%) received thromboprophylaxis. The cases and controls were comparable in age, gender and diagnoses. Compared to the controls, there was a significant (p=0.046, 47.9%) reduction in use of thromboprophylaxis. No patients had VTE before or after implementation of the algorithm. Compliance with the screening tool was excellent with 100% of the patients in the high-risk category receiving thromboprophylaxis. High-risk patients were more likely to have a BMI > 30 (35.7%), limited/altered mobility (57.1%), and to undergo complicated/repeat Surgery (64.3%) (Table 1).
Conclusions: This study demonstrates successful implementation of a VTE thromboprophylaxis screening tool that resulted in a significant reduction in thromboprophylaxis use in POSPs with no increased VTE. Further studies are needed to assess the impact of this tool on incidence of VTE and ensure universal implementation.
|Correlation to Anticoagulation (Thromboprophylaxis)|
|VTE Algorithm Factors||Correlation Coefficient||P-Value|
|Risk Score||0.336||< 0.00|
|Risk Level||0.732||< 0.00|
|Age ≥ 14||0.258||< 0.00|
|BMI > 30||0.288||< 0.00|
|Limited/Altered Mobility > 48 Hours||0.484||< 0.00|
|Surgical Procedure >120 Minutes during Current Admission||0.281||< 0.00|
|Complicated/Repeat Surgery||0.369||< 0.00|
|*Correlation is Significant at the 0.01 Level (2-Tailed) using Spearman correlation|
[Table 1: Risk Factor and Thromboprophylaxis Correlation Analysis]
To cite this abstract in AMA style:MacNevin W, Padhye K, Price V, ElHawary R, Branchford B, Stevens S, Kulkarni K. Impact of a Perioperative Venous Thromboembolism Prophylaxis Screening Tool for Pediatric Orthopedic Surgical Patients [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/impact-of-a-perioperative-venous-thromboembolism-prophylaxis-screening-tool-for-pediatric-orthopedic-surgical-patients/. Accessed January 23, 2022.
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