Venous Thromboprophylaxis in Pediatric Trauma Patients: Adult versus Pediatric Trauma Centers

Introduction: The practices of venous thromboembolism (VTE) prophylaxis are not standardized in pediatric trauma patients. We aimed to compare the rates of VTE prophylaxis and thromboembolic events in pediatric patients admitted to American College of Surgeons (ACS)-verified adult trauma centers (ATCs, nonpediatric verified) versus verified pediatric trauma centers (PTCs). Methods: We conducted a retrospective analysis of the ACS-Trauma Quality Improvement Program (2017-2020) including all pediatric (age <15 y) trauma patients with severe injuries (injury severity score ≥16). We excluded patients who died within 24 h of admission, burn patients, and those with known bleeding disorders. We stratified our cohort into two groups based on their admission to ACS-verified ATCs (nonpediatric verified) or verified PTCs. Our outcomes included receipt of VTE prophylaxis, thromboembolic events, and in-hospital mortality. Results: We identified 6730 pediatric patients over 4 y (PTC: 70.7%; ATC: 29.3%). The mean (standard deviation) age was 8 (4) y and 61.5% were male. The median emergency department Glasgow Coma Scale was 15 [9-15] and mean (standard deviation) emergency department systolic blood pressure was 116 (21) mmHg. Overall, 9.9% received VTE prophylaxis and low molecular weight heparin was the most common anticoagulant used (57.1%), followed by heparin (42.6%), and direct thrombin inhibitors (0.0%). Rates of VTE prophylaxis were significantly higher in the ATC group than PTC (12.9% versus 8.7%, P < 0.001). On univariate analysis, VTE events were rare overall (0.7%) and occurred less frequently at ATCs than at PTCs (0.4% versus 0.9%, P = 0.017); there was no difference in unplanned return to operating room or in-hospital mortality (P > 0.05). On multivariable analysis, admission to ATC was independently associated with higher odds of receipt of VTE prophylaxis (adjusted odds ratio: 1.47, confidence interval [1.21-1.79], P < 0.001). Conclusions: Considerable practice variation exists in chemoprophylaxis use between center types, while VTE events were uncommon and clinical outcomes were similar. These observations support risk-adapted, pediatric-specific guidance and judicious use rather than uniform protocol standardization. Future work should evaluate risk-stratified approaches and implementation outcomes across center types.