RESUMEN
Using the Manco-Johnson instrument in a derivation cohort of 107 children with or without a central venous catheter, upper extremity physical findings of post-thrombotic syndrome were absent, and the pain score was 0 in all but one child. Interrater reliability in an independent validation cohort (n = 38) of children with or without upper extremity deep venous thrombosis was 97%-100%.
Asunto(s)
Evaluación de Resultado en la Atención de Salud/métodos , Síndrome Postrombótico/terapia , Adolescente , Brazo/irrigación sanguínea , Niño , Preescolar , Humanos , Lactante , Estudios Prospectivos , Adulto JovenRESUMEN
OBJECTIVES: To determine a proximate family history of venous thromboembolism (VTE) in (1) the prevalence of thrombophilia; (2) the frequency of recommended changes in management resulting from thrombophilia evaluation; and (3) outcomes in longitudinal follow-up. STUDY DESIGN: Laboratory thrombophilia investigation was performed in 56 children with first- or second-degree family history of thromboembolism before age 55 years, but without personal history of thromboembolism, who were enrolled in a prospective inception cohort. VTE risk factors, family history, thrombophilia findings, and management recommendations were systematically collected, along with thromboembolism risk episodes/exposures, prophylactic anticoagulation, major bleeds, and thromboembolism events during follow-up. RESULTS: The frequencies of all thrombophilia traits were higher than the general population. Among 32 children who underwent complete laboratory evaluation, 34% had >or=2 traits. Thrombophilia testing led to recommendations for risk-based transient antithrombotic prophylaxis in 71% of subjects. No thromboembolism episodes developed during more than 900 patient-months of follow-up, although at-risk exposures were infrequent. CONCLUSION: Risk-stratified approaches to primary prevention of pediatric VTE should be further evaluated in cooperative prospective studies.