(530) Rates and Risk Factors for Venous Thromboembolism Among Critically Ill Children With Tracheostomy

Introduction: The risk of hospital-acquired venous thromboembolism (HA-VTE) is heightened among children undergoing invasive mechanical ventilation (IMV) in the pediatric intensive care unit (PICU). Estimated HA-VTE rates and risk factors among children with chronic respiratory failure and tracheostomy are not yet described. We aim to estimate the frequency of, and identify unique risk factors for, HA-VTE in this population.

Methods: We conducted a retrospective cohort study of children < 18 years with an existing tracheostomy admitted to one of 142 North American PICUs within the Virtual Pediatric Systems registry from Jan 2016-Dec 2023. Neonatal and post-operative encounters were excluded. Encounters with PICU length of stay < 1 day, tracheostomy performed during admission, and a VTE present on admission were excluded. The primary outcome was incidence of HA-VTE (including deep vein thrombosis [DVT], pulmonary embolism, or organ-specific VTE). We assessed putative risk factors for HA-VTE, including: presence of central venous catheter (CVC), IMV, prior history of HA-VTE, and comorbid inflammatory conditions. Thromboprophylaxis data are not recorded within the registry. Risks associated with HA-VTE were assessed via multiple logistic regression. A final logistic regression model was derived using features significant in univariate analyses.

Results: Of 25,778 encounters studied, 181 (0.7%) developed a HA-VTE (89.5% were DVT). The median time from admission to HA-VTE was 7 days (interquartile range [IQR]: 3-15). The median age of the population was 3 years (IQR: 1-9) and did not differ between cohorts. In our final model, a history of prior VTE (adjusted odds ratio [aOR] 19.2, 95% confidence interval [CI]: 7.1-52), inherited coagulopathy (aOR 3.6, 95% CI: 2.2-5.8), presence of CVC (aOR 3, 95% CI: 2.1-4.1), and sepsis (aOR 2.3, 95% CI: 1.6-3.2) were independent risk factors for HA-VTE.

Conclusions: In this multicenter, registry-based cohort study, HA-VTE occurred in critically ill children with tracheostomy at a similar frequency, and with similar risk factors, as previously reported for critically ill children in general. While prospective validation is needed, our findings suggest that future risk-stratified trials of thromboprophylaxis in critically ill children should include children with tracheostomy.