Background: The incidence of venous thrombo-embolism (VTE) in hospitalized children has increased by 70-200% over the last 2-decades. Given this increase, many pediatric centers have initiated electronic clinical decision supports (ECDS) to prognosticate VTE risk and recommend appropriate prophylaxis. COVID-19 is a risk factor for VTE, however ECDS algorithms developed before the COVID-19 pandemic may not accurately prognosticate VTE risk in children with COVID-19.

Aims: To identify areas for improvement of thromboprophylaxis recommendations for children admitted to hospital with COVID-19.

Methods: Inpatients with a positive COVID-19 PCR test on admission (or within 24 hours) were identified at a quaternary-care pediatric center between March 1st 2020 and January 20th 2022. The results of the institution’s automated thromboprophylaxis recommendations were compared to institutional best practice guidelines for COVID-19 thromboprophylaxis and to the thromboprophylaxis actually received by the patient. Using this data, a quality improvement (QI) initiative to improve adherence to COVID-19 thromboprophylaxis recommendations through ECDS optimization was implemented. This QI study was exempt from ethics approval.

Results: Of the 375 inpatients with COVID-19 who underwent thromboprophylaxis screening, 43 were excluded as their COVID-19 was performed >24 hours after admission and 5 were excluded for having incomplete data. Table 1 shows the characteristics of the final cohort. 179 (54.4%) patients had a D-dimer performed during their admission. The number of patients that met criteria for chemo-prophylaxis via each screening modality is shown in Figure 1. Five inpatients developed VTE; three had VTE symptoms at presentation, two were identified as high-risk for VTE by both the automated and best practice assessments but were not started on chemoprophylaxis due to family preference or a contraindication to anticoagulation.

Conclusion(s): Automated thromboprophylaxis recommendations developed prior to the COVID-19 pandemic may not identify COVID-19 patients needing chemoprophylaxis. Existing ECDS tools need to be updated to reflect COVID-19 specific risk factors for VTEs.

Table

Table 1: Characteristics of Patient’s Admitted to Hospital with COVID-19 Undergoing A Venous thromboembolism Prophylaxis Assessment

Image

Figure 1: Performance of An Automated venous thrombo-embolism -VTE- Risk Assessment in Identifying Patients Needing VTE Chemoprophylaxis as Compared to Institutional Best Practice Guidelines

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/improving-thromboprophylaxis-in-children-admitted-to-a-quaternary-care-childrens-hospital-with-covid-19/