Screening ultrasound for deep vein thrombosis detection in high-risk pediatric trauma

Infographic · Jun 2025 · 1 min read

In brief

Multi-center study of 460 high-risk pediatric trauma patients found screening ultrasound at 7 days detected asymptomatic DVT in 15.6% of cases, with 90% associated with central lines. Most DVTs occurred in patients without early chemical prophylaxis, though clinical significance of asymptomatic detection remains unclear.

Screening ultrasound at day 7 detected DVT in 15.6% of high-risk pediatric trauma patients vs 5.4% symptomatic rate without screening
90% of detected DVTs were associated with central venous lines, suggesting catheter-related thrombosis as primary mechanism
Most DVTs occurred when chemical prophylaxis was absent or delayed beyond 24 hours post-trauma
Clinical significance of asymptomatic DVT detection in pediatric trauma remains uncertain and warrants further study
Early screening ultrasound (within first week) captures majority of DVT events in this high-risk population

Written by the GCMD Library team from the infographic.

Three-panel infographic with teal headers. Left panel shows illustration of trauma patient with cervical collar and icons for Level 1 trauma centers. Center panel displays ultrasound machine illustration with lower extremity screening. Right panel uses pie charts and bar graphs in blue and purple to compare detection rates, with warning icon showing blood clot illustration.

Amanda B. Witte, Kyle Van Arendonk, Richard A. Falcone Jr., Suzanne Moody, Heather A. Hartman, Emily Evans, Rajan Thakkar, Kelli N. Patterson, Peter C. Minneci, Grace Z. Mak, Mark B. Slidell, MacKenton Johnson, Matthew P. Landman, Troy A. Markel, Charles M. Leys, Linda Cherney Stafford, Jessica Draper, David S. Foley, Cynthia Downard, Tracy M. Skaggs, Dave R. Lal, Peter F. Ehrlich & David Gourlay

Purpose: Venous thromboembolism (VTE) is a rare but significant complication among high-risk pediatric trauma patients. The NO CLOT study’s primary aim was to evaluate the safety of chemical prophylaxis against VTE in high-risk pediatric trauma patients with a secondary aim of evaluating the use of screening venous duplex ultrasound (sUS) to identify deep vein thrombosis (DVT). We hypothesized that sUS would detect asymptomatic DVT at a high rate in high-risk patients.

Methods: A prospective multi-institutional study was performed at eight level one pediatric trauma centers from 2019 to 2022. sUS was recommended 7 days after admission for all high-risk trauma patients. Univariate and multivariate analyses were performed.

Results: Of 460 high-risk trauma patients, 64/341 (18.8%) remained admitted on day 7 and underwent sUS. Ten of 64 (15.6%) had a DVT identified on sUS (median of 6.5 [IQR 5.2, 7.0] days after trauma). In 277 patients still admitted on day 7 without sUS performed, 15 (5.4%) developed symptomatic DVT (median of 6.0 [IQR 3.0, 8.0] days after trauma. For the sUS cohort, 9/10 (90%) DVTs were associated with an indwelling central venous line (CVL) and occurred either without chemical prophylaxis use at all in 4/10 (40%) or when initiated more than 24-h post-trauma in 6/10 (60%).

Conclusions: In this high-risk cohort, most DVTs were identified in the first week following injury; however, the majority were asymptomatic. Use of sUS at 1-week post-injury increases DVT detection; however, the clinical consequences of asymptomatic detection of DVT remain unknown.

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