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• Filed under: Features, Cover Story, Clinical

• Keywords: osteomyelitis, mastoiditis, data, children, central venous catheters

Pediatric VTE Surge Draws Skeptical Response

From: The eWire, 1.27.2010

by Richard Quinn

In the wake of a study that showed a 70% spike in the rate of VTE in pediatric hospitals, pediatric hospitalists and others are calling for a deeper analysis of the data.

The seven-year, multicenter study measured 11,337 hospitalized patients under the age of 18. Researchers found the annual rate of VTE increased by 70%, to 58 cases from 34 cases per 10,000 (P<0.001) (Pediatrics 2009;124(4):1001-1008). Several pediatricians note that the increase looks outsized because there has been little research on the topic over the past decade. Those interviewed say they expect more research in the future to define the breadth of the problem and potential solutions.

“I don’t think we think there’s been a seven-fold increase,” says Janna Journeycake, MD, MSCS, director of the Hemophilia and Thrombosis Program at Children's Medical Center, University of Texas Southwestern Medical Center at Dallas. “It was there all along. We just didn’t know how to recognize it.”

Mark Shen, MD, medical director of hospital medicine at Dell Children’s Medical Center in Austin, Texas, and The Hospitalist's pediatric editor, attributes a large part of the study’s findings to more awareness of VTE in the pediatric community and increases in serious bone and joint infections that lead to more central lines, a risk factor for VTE. Dr. Shen also points out that as physicians learn more about pediatric VTE, it is expected that the rate of its incidence will increase. “Before, we wouldn’t look for signs of a clot unless there were physical signs of swelling, discomfort, or shortness of breath,” he adds. “Now we are much quicker to go and do an ultrasound or look for some kind of thromboembolism.”

Dr. Journeycake sees pediatric hospitalists as the vanguard in moving forward, as long as they stay vigilant to recognize the warning signs. “The job of the hospitalist is to recognize the certain medical conditions in which VTE are most likely,” she says. “They are going to be the most critically ill kids, the ones with deep-seated infection, such as osteomyelitis, mastoiditis. … Those are going to be children with central venous catheters. Hospitalists need to realize this complication exists.”