Deep venous thrombosis in the pediatric trauma population: an unusual event: Report of three cases

The incidence of deep venous thrombosis (DVT) in the pediatric population h as been reported to be lower than in adults. Pediatric trauma patients have predisposing risk factors for DVT similar to those in the general trauma p opulation, We reviewed the records of 2746 children under 16 years of age a dmitted to our Level I pediatric trauma service from 1989 to 1997. Only thr ee cases of DVT were documented, all adolescents. DVT was located in the up per (n = 1) and lower (n = 1) extremity venous system. One patient presente d with pulmonary embolism alone without identifiable DVT. Risk factors foun d were venous system manipulations, including atriocaval shunt, subclavian central line, and hyperinflated medical antishock trousers garment. Therapy consisted of heparin followed by warfarin anticoagulation, A vena cava fil ter was inserted in one patient for whom systemic anticoagulation was contr aindicated, No DVT was seen in 1123 closed head injury patients or 29 spina l cord injury patients without associated risk factors, The thrombotic risk in pediatric trauma patients is low. Routine screening or prophylaxis is n ot indicated except for patients who are likely to remain immobile for an e xtended period of time and require prolonged rehabilitation, have venous ma nipulations, or present with clinical symptoms. Hematologic evaluation in p atients with diagnosed DVT is necessary to identify individual risk factors .