ArticlePediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies2026
Hospital-Acquired Venous Thromboembolism Among Children With Tracheostomy: A North American Virtual Pediatric Systems Registry Study, 2016-2023.
Article in Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo evaluate the frequency of hospital-acquired venous thromboembolism (HA-VTE, including limb and neck deep venous thrombosis, pulmonary embolism, and organ-specific VTE) among critically ill children with tracheostomy and determine whether surrogate markers of impaired mobility (i.e., invasive mechanical ventilation [IMV] or a high-intensity neurologic diagnosis) are associated with HA-VTE.
designMulticenter, retrospective study of the Virtual Pediatric Systems database from January 1, 2016 to December 31, 2023.
settingOne-hundred forty-two North American PICUs. PATIENTS: Children younger than 18 years with a preexisting tracheostomy, excluding neonatal and postoperative encounters, those with a PICU length of stay less than 1 day, and those with VTE present at admission.
interventionsNone. MEASUREMENTS AND MAIN
resultsOf 25,560 encounters, 181 (0.7%) developed a HA-VTE, identified at a median of 9.5 days (interquartile range: 4-19) following hospitalization. Although a larger proportion of children who developed a HA-VTE as compared with not had a high-intensity neurologic diagnosis (66.9% vs. 56.6%, p = 0.006) and greater rate of IMV exposure (92.8% vs. 81.6%, p < 0.001), these immobility surrogate markers were not associated with HA-VTE in an adjusted logistic regression model. Features independently associated with HA-VTE included: prior VTE (adjusted odds ratio [aOR]: 19.2; 95% CI, 7.1-52); central venous catheterization (CVC, aOR: 3; 95% CI, 2.1-4.2); comorbid infection (aOR: 2.2; 95% CI, 1.6-3.2); and an inherited hypercoagulability (aOR: 3.5; 95% CI, 2.6-5.7) (all p < 0.001). Among patients with CVC, concomitant high-intensity neurologic impairment diagnosis (aOR 1.7; 95% CI, 1.1-2.8) was independently associated with HA-VTE.
conclusionsIn this multicenter study of critically ill children with tracheostomy, HA-VTE occurred in 0.7% of encounters and was associated with presence of a CVC, comorbid infection, prior VTE and inherited hypercoagulability. A surrogate marker of immobility (i.e., high-intensity neurologic diagnoses) was associated with HA-VTE among patients with a CVC.
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