VPB0288 - Improving Thromboprophylaxis in Children Admitted to a Quaternary Care Children’s Hospital with COVID-19

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: Virtual

Presenting Author(s)

Adam P. Yan, MD

Pediatric Hematologist & Clinical Informatics Fellow
Boston Children's Hospital and Harvard Medical School
Brookline, Massachusetts, United States

Co-Author(s)

CP

Chase Parsons

Pediatric Hospitalist, Instructor of Pediatrics
Boston Children's Hospital / Harvard Medical School
Boston, Massachusetts, United States
GC

Gregory Caplan

Patient Safety and Quality Expert
Boston Children’s Hospital Program for Patient Safety and Quality
Boston, Massachusetts, United States
DK

Daniel P. Kelly

Pediatric Intensive Care Unit Attending
Division of Medical Critical Care, Boston Children's Hospital and Harvard Medical School
Boston, Massachusetts, United States
JD

Julie Duzan

Pediatric Anti-Coagulation Nurse Specialist
Division of Hematology and Oncology, Boston Children's Hospital and Harvard Medical School
Boston, Massachusetts, United States
ED

Emily Drake

Pediatric Anti-Coagulation Nurse Practitioner
Division of Hematology and Oncology, Boston Children's Hospital and Harvard Medical School
Boston, Massachusetts, United States
RK

Riten Kumar, MD, MSc

Associate Professor of Pediatrics
Dana-Farber/Boston Children's Cancer and Blood Disorders Center.
Boston, Massachusetts, United States

Background: The incidence of venous thrombo-embolism (VTE) in hospitalized children has increased by 70-200% over the last 2-decades. Given this increase, many pediatric centers have initiated electronic clinical decision supports (ECDS) to prognosticate VTE risk and recommend appropriate prophylaxis. COVID-19 is a risk factor for VTE, however ECDS algorithms developed before the COVID-19 pandemic may not accurately prognosticate VTE risk in children with COVID-19.

Aims: To identify areas for improvement of thromboprophylaxis recommendations for children admitted to hospital with COVID-19.

Methods: Inpatients with a positive COVID-19 PCR test on admission (or within 24 hours) were identified at a quaternary-care pediatric center between March 1st 2020 and January 20th 2022. The results of the institution’s automated thromboprophylaxis recommendations were compared to institutional best practice guidelines for COVID-19 thromboprophylaxis and to the thromboprophylaxis actually received by the patient. Using this data, a quality improvement (QI) initiative to improve adherence to COVID-19 thromboprophylaxis recommendations through ECDS optimization was implemented. This QI study was exempt from ethics approval.

Results: Of the 375 inpatients with COVID-19 who underwent thromboprophylaxis screening, 43 were excluded as their COVID-19 was performed >24 hours after admission and 5 were excluded for having incomplete data. Table 1 shows the characteristics of the final cohort. 179 (54.4%) patients had a D-dimer performed during their admission. The number of patients that met criteria for chemo-prophylaxis via each screening modality is shown in Figure 1. Five inpatients developed VTE; three had VTE symptoms at presentation, two were identified as high-risk for VTE by both the automated and best practice assessments but were not started on chemoprophylaxis due to family preference or a contraindication to anticoagulation.

Conclusion(s): Automated thromboprophylaxis recommendations developed prior to the COVID-19 pandemic may not identify COVID-19 patients needing chemoprophylaxis. Existing ECDS tools need to be updated to reflect COVID-19 specific risk factors for VTEs.