Venous Thromboembolism Following Pediatric Traumatic Spinal Injuries Is Associated with Injury Severity and Longer Hospital Stays

J Neurosurg Spine, 2022 · DOI: 10.3171/2021.3.SPINE201981 · Published: January 1, 2022

Simple Explanation

This study looks at the occurrence of venous thromboembolism (VTE) in children who have suffered traumatic spinal injuries (TSI). VTE, which includes deep vein thrombosis and pulmonary embolism, can cause serious complications. The study found that VTE occurred in a small percentage of these patients, and it was more likely to happen in those with more severe injuries, such as spinal cord injuries or injuries to other parts of the body. The researchers suggest that preventing VTE in these children could reduce the burden on hospitals and improve long-term health outcomes. They also highlight the importance of considering spinal cord injury and low Glasgow Coma Scale (GCS) scores as key risk factors for VTE in this population.

Study Duration

2011–2014

Participants

22,752 pediatric TSI patients

Evidence Level

Retrospective cohort analysis

Key Findings

1
VTE occurred in 0.8% of pediatric TSI patients during initial hospitalization.
2
Patients with moderate or severe Glasgow Coma Scale scores, epidural hematoma, abdominal or lower extremity injuries, and obesity had greater odds of developing VTE.
3
Spinal cord injury at any level was significantly associated with developing VTE (OR 2.5; 95% CI 1.8–3.5).

Research Summary

This study aimed to assess the incidence of VTE among pediatric TSI patients, risk factors and protective factors for VTE development, and initial hospital course and disposition for these patients. Injury severity is broadly associated with an increased odds of developing VTE; specific risk factors include concomitant injuries such as cranial epidural hematoma, spinal cord injury, and lower extremity injury. Patients with VTE also require hospital-based and rehabilitative care at greater rates than other TSI patients.

Practical Implications

Improved VTE Prophylaxis

The study identifies specific risk factors (spinal cord injury, low GCS) to be incorporated into pediatric VTE prophylaxis guidelines.

Mechanical Prophylaxis Consideration

Mechanical prophylaxis (sequential compression devices) may be a safer method than anticoagulation in pediatric TSI patients due to the risk of bleeding.

Public Health Initiatives

Coordinated initiatives aimed at decreasing drunk or intoxicated driving could help lower the injury rate further, as could improved education for parents about age-appropriate car seat use.

Study Limitations

1
Inability to assess long-term prognostic information.
2
Data may fail to capture VTEs that occur beyond the primary endpoint (i.e. after discharge).
3
Post-trauma complications may be underreported in the NTDB.

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