Do Guidelines Change Practice: A Comparison of Single-Center Adherence After Publication of Pediatric Venothromboembolism Guidelines.

Venothromboembolism (VTE) is rare in pediatric trauma but can have devastating consequences. While chemical prophylaxis guidelines exist in adult trauma, guidelines for pediatric populations are sparse. Adherence to the Eastern Association of the Surgery of Trauma (EAST) and Pediatric Trauma Society (PTS) guidelines is unclear. Our objective was to evaluate rate of VTE prophylaxis and adherence to current guidelines in our pediatric trauma population.

METHODS We performed a retrospective cohort study at a single ACS-verified adult Level I/pediatric Level II Trauma Center from the years 2014-2024. Patients aged 7-18 were included. A subgroup based on the EAST/PTS guidelines. VTE prophylaxis, deep vein thrombosis (DVT) or pulmonary embolism (PE), injury severity score (ISS), and pubertal status.

RESULTS During the study period, 1271 patients met inclusion criteria. Four patients (0.31%) experienced VTE. Three patients (0.24%) had a bleeding complication. While 787 patients met criteria for prophylaxis by EAST/PTS guidelines, only 279 patients (35.4%) received prophylaxis. Use of chemical prophylaxis increased after publication of EAST/PTS guidelines (20.6% vs 39.9%, p < 0.001). Of patients who qualified for chemical prophylaxis by the EAST/PTS guidelines, two patients (0.3%) developed VTE, while 1 (0.1%) developed a bleeding complication. One patient who developed a DVT was younger than 15 with an ISS <25 and did not meet criteria by EAST/PTS guidelines.

CONCLUSION Adherence to pediatric VTE prophylaxis guidelines increased over the study period without increase in adverse events. There was no difference in VTE incidence, but VTE was rare.