Factors associated with venous thromboembolism in the paediatric intensive care unit: A systematic review and meta-analysis

Background Paediatric critical care practitioners have become increasingly concerned about venous thromboembolism (VTE). Although a wide range of factors associated with VTE in paediatric intensive care units (PICUs) have been identified, the strength and consistency of effect sizes are uncertain. Design Systematic review and meta-analysis of case-control and cohort studies. Methods We searched six electronic databases from inception to 20 June 2021. The study population consisted of hospitalized children aged 0-21 years. Our primary outcome was factors associated with VTE in the PICU. We pooled effect sizes as odds ratios (ORs) using random-effects models for each factor that was examined in at least three distinct samples. We assessed study quality using the Newcastle-Ottawa Scale and examined between-study heterogeneity. Results The meta-analysis showed that age <1 year (OR = 1.80, 95% confidence interval [CI]: 1.08-3.01), sepsis (OR = 3.14, 95% CI: 1.55-6.38), central venous catheterization (CVC; OR = 7.76, 95% CI: 3.63-16.61), and mechanical ventilation (OR = 2.80, 95% CI: 1.90-4.13) was associated with an increased VTE risk. Conclusion We identified that infancy, sepsis, and the use of CVC and mechanical ventilation therapies are more likely to cause VTE in critically ill children. It is still necessary to identify the association between VTE and important clinical variables (e.g., postpubertal age, postoperative status). Relevance to Clinical Practice This review provides evidence that supports the factors associated with VTE in specific clinical settings and suggests that nurses should focus on the precise identification of the factors associated with VTE.