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Predictive Ability of the Braden QD Scale for Hospital-Acquired Venous Thromboembolism in Hospitalized Children

      Abstract

      Purpose

      Hospital-acquired venous thromboembolisms (HA-VTEs) are increasingly common in pediatric inpatients and associated with significant morbidity and cost. The Braden QD Scale was created to predict the risk of hospital-acquired pressure injury (HAPI) and is used broadly in children's hospitals. This study evaluated the ability of the Braden QD Total score to predict risk of HA-VTE at a quaternary children's hospital.

      Methods

      To analyze the predictive potential of the Braden QD Total score and subscores for HA-VTEs, the researchers performed univariate logistic regressions. The increase in a patient's odds of developing an HA-VTE for every 1-point increase in each Braden QD score was evaluated. Each model was evaluated using a 5-fold cross-validated area-under-the-curve of the corresponding receiver operating characteristic curve (AUROC).

      Results

      This study analyzed 27,689 pediatric inpatients. HA-VTE occurred in 135 patients. The odds of HA-VTE incidence increased by 29% (odds ratio 1.29, 95% confidence interval [CI] 1.25–1.34, p < 0.001) for every 1-point increase in a patient's Braden QD Total score. The AUROC was 0.81 (95% CI 0.77–0.85).

      Conclusion

      The Braden QD Scale is a predictor for HA-VTE, outperforming its original intended use for predicting HAPI and performing similarly to other HA-VTE predictive models. As the Braden QD Total score is currently recorded in the electronic health records of many children's hospitals, it could be practically and easily implemented as a tool to predict which patients are at risk for HA-VTE.
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      References

        • Shoag J
        • et al.
        Venous thromboembolism in pediatrics.
        Pediatr Rev. 2021; 42: 78-89
        • Georgeades C
        • Van Arendonk K
        • Gourlay D.
        Venous thromboembolism prophylaxis after pediatric trauma.
        Pediatr Surg Int. 2021; 37: 679-694
        • Jaffray J
        • Bauman M
        • Massicotte P.
        The impact of central venous catheters on pediatric venous thromboembolism.
        Front Pediatr. 2017 Jan 23; 5: 5
        • Faustino EVS
        • Raffini LJ.
        Prevention of hospital-acquired venous thromboembolism in children: a review of published guidelines.
        Front Pediatr. 2017 Jan 26; 5: 9
        • Witmer CM
        • Takemoto CM.
        Pediatric hospital acquired venous thromboembolim.
        Front Pediatr. 2017 Sep 19; 5: 198
        • Boulet SL
        • et al.
        Trends in venous thromboembolism-related hospitalizations, 1994–2009.
        Pediatrics. 2012; 130: e812-e820
        • Raffini L
        • et al.
        Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007.
        Pediatrics. 2009; 124: 1001-1008
        • Betensky M
        • et al.
        How we manage pediatric deep venous thrombosis.
        Semin Intervent Radiol. 2017; 34: 35-49
        • Tarango C
        • et al.
        Duration of anticoagulant therapy in pediatric venous thromboembolism: current approaches and updates from randomized controlled trials.
        Expert Rev Hematol. 2018; 11: 37-44
        • Goudie A
        • et al.
        Costs of venous thromboembolism, catheter-associated urinary tract infection, and pressure ulcer.
        Pediatrics. 2015; 136: 432-439
        • Branchford BR
        • Jaffray J
        • Mahajerin A.
        Editorial: Pediatric venous thromboembolism.
        Front Pediatr. 2018 Sep 27; 6: 269
      1. Children's Hospitals’ Solutions for Patient Safety. SPS Recommended Bundles—Hospital Acquired Condition: VTE, version 3.0. Hilbert K, et al. Oct 24, 2016. Accessed Jul 18, 2022. http://www.solutionsforpatientsafety.org/wp-content/uploads/SPS-Recommended-Bundles.pdf.

        • Monagle P
        • Newall F.
        Management of thrombosis in children and neonates: practical use of anticoagulants in children.
        Hematology Am Soc Hematol Educ Program. 2018 Nov 30; 2018: 399-404
        • Hanson SJ
        • et al.
        Effectiveness of clinical guidelines for deep vein thrombosis prophylaxis in reducing the incidence of venous thromboembolism in critically ill children after trauma.
        J Trauma Acute Care Surg. 2012; 72: 1292-1297
        • Connelly CR
        • et al.
        A clinical tool for the prediction of venous thromboembolism in pediatric trauma patients.
        JAMA Surg. 2016; 151: 50-57
        • Mahajerin A
        • et al.
        Prophylaxis against venous thromboembolism in pediatric trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma and the Pediatric Trauma Society.
        J Trauma Acute Care Surg/. 2017; 82: 627-636
        • Landisch RM
        • et al.
        Evaluation of guidelines for injured children at high risk for venous thromboembolism: a prospective observational study.
        J Trauma Acute Care Surg. 2017; 82: 836-844
        • Petty JK.
        Venous thromboembolism prophylaxis in the pediatric trauma patient.
        Semin Pediatr Surg. 2017; 26: 14-20
        • Yen J
        • et al.
        Risk factors for venous thromboembolism in pediatric trauma patients and validation of a novel scoring system: the risk of clots in kids with trauma score.
        Pediatr Crit Care Med. 2016; 17: 391-399
        • Cunningham AJ
        • et al.
        Pediatric trauma venous thromboembolism prediction algorithm outperforms current anticoagulation prophylaxis guidelines: a pilot study.
        Pediatr Surg Int. 2020; 36: 373-381
        • Jaffray J
        • et al.
        A multi-institutional registry of pediatric hospital-acquired thrombosis cases: the Children's Hospital-Acquired Thrombosis (CHAT) Project.
        Thromb Res. 2018; 161: 67-72
        • Jaffray J
        • et al.
        Development of a risk model for pediatric hospital-acquired thrombosis: a report from the Children's Hospital-Acquired Thrombosis Consortium.
        J Pediatr. 2021; 228 (e1): 252-259
        • Walker SC
        • et al.
        A real-time risk-prediction model for pediatric venous thromboembolic events.
        Pediatrics. 2021; 147e2020042325
        • Curley MAQ
        • Quigley SM
        • Lin M.
        Pressure ulcers in pediatric intensive care: incidence and associated factors.
        Pediatr Crit Care Med. 2003; 4: 284-290
        • Johnson AK
        • et al.
        Key drivers in reducing hospital-acquired pressure injury at a quaternary children's hospital.
        Pediatr Qual Saf. 2020 Apr 7; 5: e289
        • Frank G
        • et al.
        Impact of a pressure injury prevention bundle in the Solutions for Patient Safety Network.
        Pediatr Qual Saf. 2017 Feb 15; 2: e013
      2. Children's Hospitals’ Solutions for Patient Safety. Operational Definitions. Mar 2019. Accessed Jul 18, 2022. https://www.solutionsforpatientsafety.org/wp-content/uploads/sps-operating-definitions.pdf.

        • Arlot S
        • Celisse A.
        A survey of cross-validation procedures for model selection.
        Stat Surv. 2010; 4: 40-79
        • Andrew M
        • et al.
        Venous thromboembolic complications (VTE) in children: first analyses of the Canadian registry of VTE.
        Blood. 1994 Mar 1; 83: 1251-1257
        • Jaffray J
        • et al.
        Peripherally inserted center catheters lead to a high risk of venous thromboembolism in children.
        Blood. 2020; 135: 220-226
        • Fleming SL
        • et al.
        Performance of a commonly used pressure injury risk model under changing incidence.
        Jt Comm J Qual Patient Saf. 2022; 48: 131-138