Risk-prediction tool for identifying hospitalized children with a predisposition for development of venous thromboembolism: Peds-Clot clinical Decision Rule

A. A. Sharathkumar, A. Mahajerin, L. Heidt, K. Doerfer, M. Heiny, Terry Vik, Robert Fallon, A. Rademaker

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: The prevalence of VTE is increasing in tertiary pediatric hospitals. Identification of high-risk populations using uniform criteria is required to develop evidence-based VTE prevention guidelines. Objective: To develop a VTE risk prediction rule, the Peds-Clot clinical Decision Rule (PCDR), to identify high-risk children who were at increased risk of developing VTE. Methods: This retrospective case-control study developed the PCDR using a derivation cohort (173 cases, 346 controls) and validated it on a separate validation cohort (100 cases, 100 controls). A uniform data collection strategy was applied to derive both the samples. Conditional logistic regression analyses were used to develop a risk-prediction model. Each significant predictor was assigned a score based on its beta coefficient and the PCDR was developed. ROC curves were derived to test the performance of the PCDR. Results: Characteristics of derivation and validation cohorts were comparable. Six risk factors (positive blood stream infection, central venous catheter, direct admission to ICU/NICU, hospitalization for ≥7days, immobilization for > 72 h, and use of birth control pills) formed the final risk prediction model (risk score range, 0.5-9.5). A risk score of 3 or more identified high-risk children at a sensitivity of 70% and specificity of 80% and AUC of 0.852 (95% confidence interval, 0.814-0.890). The application of a risk score to the validation sample showed sensitivity 57% and specificity 88% and an AUC of 0.875 (95% confidence interval, 0.82-0.924). Conclusion: Incorporation of the PCDR in routine clinical care can be an attractive strategy to identify high-risk hospitalized children with a predisposition for VTE. The clinical utility of the PCDR needs validation in prospective studies.

Original languageEnglish
Pages (from-to)1326-1334
Number of pages9
JournalJournal of Thrombosis and Haemostasis
Volume10
Issue number7
DOIs
StatePublished - Jul 2012

Fingerprint

Hospitalized Child
Venous Thromboembolism
Area Under Curve
Confidence Intervals
Sensitivity and Specificity
Pediatric Hospitals
Central Venous Catheters
Contraception
Tertiary Care Centers
ROC Curve
Immobilization
Case-Control Studies
Hospitalization
Logistic Models
Regression Analysis
Prospective Studies
Guidelines

Keywords

  • Children
  • Venous thromboembolism (VTE)
  • VTE risk-prediction tool

ASJC Scopus subject areas

  • Hematology

Cite this

Risk-prediction tool for identifying hospitalized children with a predisposition for development of venous thromboembolism : Peds-Clot clinical Decision Rule. / Sharathkumar, A. A.; Mahajerin, A.; Heidt, L.; Doerfer, K.; Heiny, M.; Vik, Terry; Fallon, Robert; Rademaker, A.

In: Journal of Thrombosis and Haemostasis, Vol. 10, No. 7, 07.2012, p. 1326-1334.

Research output: Contribution to journalArticle

Sharathkumar, A. A. ; Mahajerin, A. ; Heidt, L. ; Doerfer, K. ; Heiny, M. ; Vik, Terry ; Fallon, Robert ; Rademaker, A. / Risk-prediction tool for identifying hospitalized children with a predisposition for development of venous thromboembolism : Peds-Clot clinical Decision Rule. In: Journal of Thrombosis and Haemostasis. 2012 ; Vol. 10, No. 7. pp. 1326-1334.
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abstract = "Background: The prevalence of VTE is increasing in tertiary pediatric hospitals. Identification of high-risk populations using uniform criteria is required to develop evidence-based VTE prevention guidelines. Objective: To develop a VTE risk prediction rule, the Peds-Clot clinical Decision Rule (PCDR), to identify high-risk children who were at increased risk of developing VTE. Methods: This retrospective case-control study developed the PCDR using a derivation cohort (173 cases, 346 controls) and validated it on a separate validation cohort (100 cases, 100 controls). A uniform data collection strategy was applied to derive both the samples. Conditional logistic regression analyses were used to develop a risk-prediction model. Each significant predictor was assigned a score based on its beta coefficient and the PCDR was developed. ROC curves were derived to test the performance of the PCDR. Results: Characteristics of derivation and validation cohorts were comparable. Six risk factors (positive blood stream infection, central venous catheter, direct admission to ICU/NICU, hospitalization for ≥7days, immobilization for > 72 h, and use of birth control pills) formed the final risk prediction model (risk score range, 0.5-9.5). A risk score of 3 or more identified high-risk children at a sensitivity of 70{\%} and specificity of 80{\%} and AUC of 0.852 (95{\%} confidence interval, 0.814-0.890). The application of a risk score to the validation sample showed sensitivity 57{\%} and specificity 88{\%} and an AUC of 0.875 (95{\%} confidence interval, 0.82-0.924). Conclusion: Incorporation of the PCDR in routine clinical care can be an attractive strategy to identify high-risk hospitalized children with a predisposition for VTE. The clinical utility of the PCDR needs validation in prospective studies.",
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