RESULTS:: The mean age of the affected patients was 14.3 (95% confidence interval, 13.3-15.3) years and 61% were males. The average body mass index was 28 (95% confidence interval, 25-31). Forty-four percent of the patients were diagnosed with deep venous thrombosis (DVT) only, 26% with pulmonary embolism (PE) only, and 30% with both DVT and PE. Majority of the children had DVT involving the popliteal area or thigh (16 cases each). Lower extremity surgery (29 cases, including proximal femoral/tibial osteotomies, internal fixation of long bone fractures, anterior cruciate ligament reconstruction, and resection of osteochondroma around the knee) and adolescence (28 cases) were the 2 most commonly cited associations. Other cases were noted with spinal surgery (8 children) and musculoskeletal infections (7 children). Three patients developed a postphlebitic syndrome, 1 had recurrent DVT and 2 children died. Both deceased children were diagnosed with DVT and PE including a 9-year-old child with a positive family history of antithrombin-3 deficiency that was not noted preoperatively.
CONCLUSIONS:: Although uncommon, potentially fatal VTE can occur among children with a variety of musculoskeletal ailments. Obtaining a family history suggestive of thrombophilia preoperatively should be encouraged. Further investigation is warranted to ascertain the role of prophylaxis against VTE among children in an orthopaedic practice.
LEVEL OF EVIDENCE:: Level IV-case series.
PMID: 23812156 [PubMed - as supplied by publisher]
Read more... http://www.ncbi.nlm.nih.gov/pubmed/23812156?dopt=Abstract
