Incidence of Venous Thromboembolism in a Paediatric Population Undergoing Neurosurgical Intervention

Abstract

Background and Aims: Knowledge of incidence and prevention of venous thromboembolism (VTE) in pediatric patients who undergo neurosurgical procedures is limited when compared to their adult counterparts. Risk factors for developing venous thromboembolism in pediatric patients are also less defined. Multiple systematic reviews and meta-analyses have found that chemoprophylaxis is effective in the prevention of venous thromboembolism in adult populations. However, the use of chemopro¬phylaxis against venous thromboembolism in children varies according to size and age. The study aims to determine the incidence of venous thromboembolism following neurosurgical intervention among pediatric population. Methods: This is a retrospective study that included 273 pediatric patients who underwent 396 elective or emer¬gency neurosurgical interventions involving brain or spine between 2016 and 2019 at King Abdulaziz University Hospital. We recorded frequency of imaging ordered to diagnose VTE (e.g., computed tomography [CT] scans/ CT pulmonary angiograms [CTPA] of chest, and/or Doppler ultrasound [US] scans of the lower legs) as well incidence of VTE within 90 days post-operatively. Results: Only 0.5% of patients developed venous thromboembolism, all presented as pulmonary embolism, while no patients developed Deep Venous Thrombosis of legs. Only three patients underwent CT/ CTPA imaging of chest (0.8%), and no US dopplers were ordered. Conclusions: Given low incidence of VTE in this population, the use pharmacological agents for venous thromboembolism prophylaxis in neurosurgical pediatric population requires further evaluation to determine the benefit and minimize the harm associated with such agents.

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