(802) Mechanical Thromboprophylaxis Prescribing Trends Among U.S. Pediatric Intensive Care Units

Introduction: Hospital-acquired venous thromboembolism (HA-VTE) occurs in 1 in 50 critically ill children. While anticoagulant thromboprophylaxis (TP) may be effective, anticoagulants may increase the risk of bleeding. Mechanical TP (mTP) may also be prescribed to reduce HA-VTE risk but no evidence-based pediatric mTP guidelines exist. We sought to characterize prescribing trends for mTP and the frequency of HA-VTE among critically ill children.

Methods: We performed a multicenter retrospective cohort study of children 0-17 years of age hospitalized in 22 pediatric intensive care units participating in the Pediatric Heath Information Systems registry from 2017 - 2022. The primary outcome was mTP prescribing (assessed by calendar year and hospital center) identified by supply clinical transaction codes for sequential compression devices and compression stockings. The secondary outcome was HA-VTE frequency defined as deep venous thrombosis and pulmonary embolism. Descriptive data included admission diagnoses and indications, prothrombotic factors (i.e., presence of central venous catheterization [CVC], mechanical ventilation [MV], hematologic malignancy, and infectious diseases), and length of stay (LOS). Statistics were descriptive (means, medians, and proportions), comparative (chi-square and Wilcoxon rank sum tests), and associative (JoinPoint regression).

Results: Of the 80,178 encounters studied, 6,559 (8.2%) were prescribed mTP ranging by hospital center from 1.2% to 21.1%. A JoinPoint regression for annual mTP prescribing yielded a linear model with a negative trend (-1.1%/year) from a mean mTP rate of 8.6% in 2017 to 4% in 2022 (R2=0.4). Frequently, mTP was prescribed for children receiving post operative care (60.3%), MV (41.7%), or with CVC (19.5%). Compared to those without mTP, those with experienced a longer median LOS (8 [4-17] vs 5 [3,10] days, P< 0.001). The overall HA-VTE rate was 2.3% and, compared to those without mTP, those prescribed mTP had a greater frequency of HA-VTE (4.9% vs 2.1%, P< 0.001).

Conclusions: This multicenter study found mTP prescribing rates were low among critically ill children with variation by hospital center and admission indication. Prospective multicenter studies are needed to inform future clinical trials of mTP for HA-VTE prevention in critically ill children.