A Narrative Review on the Approach to Hospital-Acquired Venous Thromboembolism in Pediatric Trauma and Critically Ill Children

Pediatric traumas and critical illnesses are known to confer increased risk for hospital-acquired venous thromboembolism (HA-VTE) in children. The development of HA-VTE in children is associated with increased mortality and disabling co-morbidities. In this narrative review, we discuss the current literature on HA-VTE in children with severe trauma and those who are critically ill. The pediatric literature in this field continues to grow with randomized trials and guidelines actively being developed. We describe the available data related to the frequency of HA-VTE specific to these populations, as well as the pathophysiological concepts and considerations for its development and management. We outline an approach to HA-VTE in these two groups by delving into risk assessment and the identification of risk factors that accrue in these children, the need to assess for thromboprophylaxis and balance its risks and benefits, the clinical presentation and imaging modalities to confirm the diagnosis of HA-VTE, and management principles for developed HA-VTE. We use some of the currently available guidelines, including those of the Eastern Association for the Surgery of Trauma and Pediatric Trauma Society and the recently updated 2024 American Society of Hematology/International Society on Thrombosis and Haemostasis guidelines on the management of VTE in children, to aid in our discussion.