All trauma patients aged 10-17 years require VTE risk assessment at admission and reassessment at 48-72 hours of hospitalization.

VTE prophylaxis should be initiated within 24 hours of risk assessment based on stratification: low, moderate, or high risk categories.

High-risk patients (altered mobility plus ≥2 risk factors) require both mechanical and pharmacologic prophylaxis unless contraindicated.

Consult surgery before starting pharmacologic prophylaxis in surgical patients to assess bleeding risk; use hematology for alternative agents.

Mechanical prophylaxis (SCDs/GCS) should be applied to both legs and used continuously except during ambulation or bathing.

DVT Prophylaxis for Trauma Patients | GlobalCastMD Clinical Guidelines

Guideline document

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Topic overview

Clinical guideline for VTE risk assessment and prophylaxis in trauma patients aged 10-17 years. Defines risk categories (low, moderate, high) based on mobility status and additional risk factors, with corresponding prophylaxis recommendations using mechanical devices or pharmacologic agents within 24 hours of assessment.

Key Takeaways

All trauma patients aged 10-17 years require VTE risk assessment at admission and reassessment at 48-72 hours of hospitalization.
VTE prophylaxis should be initiated within 24 hours of risk assessment based on stratification: low, moderate, or high risk categories.
High-risk patients (altered mobility plus ≥2 risk factors) require both mechanical and pharmacologic prophylaxis unless contraindicated.
Consult surgery before starting pharmacologic prophylaxis in surgical patients to assess bleeding risk; use hematology for alternative agents.
Mechanical prophylaxis (SCDs/GCS) should be applied to both legs and used continuously except during ambulation or bathing.

Keywords

Hashtags

#VTEPrevention #PediatricTrauma #DVTProphylaxis #TraumaCare

Full guideline text

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Guideline CCHMC Trauma Service Operation Guidelines Title: Venous Thromboembolism (VTE) Prophylaxis Effective Date: 06/2018 Number: TR-23 Page: 1 of 5 1.0 SCOPE 1.1 Care of the Trauma Services Patient at CCHMC. 2.0 DEFINITIONS 2.1. Altered mobility: A permanent or temporary state in which the child has a limitation in independent, purposeful physical movement of the body or of one or more extremities. 2.2. Deep Vein Thrombosis (DVT): A blood clot (thrombus) that was initially formed in a deep (non-peripheral) vein. 2.3. Graduated Compression Stocking (GCS): Elastic stockings, either knee- or thigh-high, also known as TED hose. 2.4. Risk category: Refer to VTE Risk Factors algorithm 2.4.1. Low risk: No VTE risk factors 2.4.2. Moderate risk: Multiple risk factors for VTE in the absence of altered mobility or has altered mobility with one or fewer additional risk factors. 2.4.3. High risk: Altered mobility plus two or more additional risk factors 2.5. Sequential Compression Device (SCD): A device designed to intermittently squeeze blood from underlying deep veins in the leg upon compression of an inflatable sleeve, and to allow the blood to flow again when it decompresses. 2.6. Venous Thromboembolism (VTE): A blood clot (thrombus) in a vein or one that has broken free and is carried in the bloodstream (embolus). 3.0 GUIDELINE 3.1. It is recommended that patients age 10 – 17 years be assessed for VTE risk factors, and based on that assessment, assigned to a risk category (low, moderate, high). 3.1.1. At the time of inpatient admission; and 3.1.2. Reassessed at 48 – 72 hours of hospitalization. 3.1.3. This should be documented in the patient’s medical record. 3.2. It is recommended that VTE prophylaxis be administered based on risk category as soon as feasible, but within 24 hours of assessment, unless there are contraindications (See algorithm). 3.3. If planning to initiate pharmacologic prophylaxis it is recommended: 3.3.1. In surgical patients to seek surgical input regarding bleeding risk prior to initiation 3.3.2. See BESt #049 for management of LMWH prophylaxis 3.3.3. Obtain Hematology consultation when considering alternative pharmacologic agents. 3.4. Refer to BESt 181 algorithm below for Risk Category Assessment and Prophylaxis for VTE. Venous Thromboembolism (VTE) Prophylaxis Page 2 of 5 • See next page for page 2 of risk assessment Venous Thromboembolism (VTE) Prophylaxis Page 3 of 5 Venous Thromboembolism (VTE) Prophylaxis Page 4 of 5 Venous Thromboembolism (VTE) Prophylaxis Page 5 of 5 4.0 REFERENCES 4.1 Multidisciplinary VTE Prophylaxis BESt Team, Cincinnati Children's Hospital Medical Center: Best Evidence Statement Venous Thromboembolism (VTE) Prophylaxis in Children and Adolescents, http://www.cincinnatichildrens.org/service/j/anderson-center/evidence-based-care/bests/, BESt 181, pages 1-14, Date 2/18/14. 5.0 APPROVALS All revisions of this guideline are approved by the Trauma Service Department. This guideline is reviewed every three years or sooner if deemed necessary. Policy authority for this document resides with the Trauma Service Department. This guideline is approved by the Trauma Services Manager and the Director of Trauma Services. HISTORY Original Date 06/2004 Revision Date 05/15, 06/18 Review Date

How to cite: GlobalCastMD. DVT Prophylaxis for Trauma Patients. GlobalCastMD Medical Library. https://library.globalcastmd.com/guideline/1851