A Narrative Review on the Approach to Hospital-Acquired Venous Thromboembolism in Pediatric Trauma and Critically Ill Patients

Pediatric trauma and critical illness are known to confer increased risk for hospital-acquired venous thromboembolism (HA-VTE) in children. They are associated with increased mortality and the development of disabling co-morbidities. In this narrative review we discuss the current literature on HA-VTE in children with severe trauma or those who are critically ill. Pediatric literature in this field continues to grow with randomized trials and guidelines actively being developed. We describe available data related to the frequency of HA-VTE specific to these populations, as well as the pathophysiological concepts and considerations for its development and management. We outline an approach to HA-VTE in these 2 groups by delving into risk assessment and identification of risk factors that accrue in these children, the need to assess for thromboprophylaxis and balance its risks and benefits, the clinical presentation and imaging modalities to confirm diagnosis of HA-VTE, and management principles for developed HA-VTE. We used some of the available guidelines including the Eastern Association for the Surgery of Trauma and Pediatric Trauma Society and the recently updated 2024 American Society of Hematology/International Society for Thrombosis and Haemostasis guidelines on the management of VTE in children, to aid in our discussion.