A PROSPECTIVE-STUDY OF THE INCIDENCE OF DEEP VENOUS THROMBOSIS IN HOSPITALIZED CHILDREN

Purpose: It is commonly believed that the incidence of deep venous thr ombosis (DVT) in hospitalized children is less than in adults. However , it is possible that the disease is significantly underdiagnosed in c hildren because the index of suspicion of pediatric practitioners is l ow, a substantial number of patients may have no symptoms, and DVT scr eening is not routinely performed. We therefore undertook a prospectiv e study to define the incidence of DVT in hospitalized children with n o symptoms. Methods: Patients included in the study were those younger than 18 years of age who were hospitalized for more than 72 hours and were identified to have two or more risk factors for the development of DVT and had had at least one screening duplex scan. Risk factors fo r the development of DVT considered were a history of DVT or pulmonary embolism, recent operation, immobilization, trauma, stroke or acute n eurologic deficit, the presence of cancer, sepsis, greater than 150% i deal body weight, a hypercoagulable state, and the presence of a femor al venous catheter. Results: Over the 9-month period ending December 1 994, 1997 patients 17 years of age and younger were admitted to the ho spital, and 59 patients including 19 girls and 40 boys were enrolled i n the study. The one patient with DVT was a 17-year-old boy hospitaliz ed after a motor vehicle accident with blunt head trauma and a neurolo gic deficit who underwent multiple orthopedic and neurosurgical proced ures. Conclusions: The development of acute DVT in children is unusual . As a result, DVT prophylaxis and screening is unnecessary in young c hildren with only two risk factors for the development of the disease. Young age appears to be an important protective risk factor for the p revention of DVT.