Multisite validation of a venous thrombosis risk model in critically ill children through the CHAT Consortium
Abstract
Abstract Critically ill children are at a high risk for hospital-associated venous thromboembolism (HA-VTE). Developing a validated risk assessment model (RAM) to identify children who may benefit from thromboprophylaxis is essential. We aimed to prospectively validate the Children’s Healthcare Advancements in Thrombosis (CHAT)–intensive care unit (ICU) VTE RAM (CHAT-ICU RAM), containing 5 clinically significant variables: central venous catheter, immobility, congenital heart disease, autoimmune or inflammatory conditions, and hospital stay of ≥3 days in a multicenter cohort study. Randomly selected patients aged 0 to 21 years admitted to a pediatric ICU (PICU) at 32 institutions were monitored through medical record review for HA-VTE. Discrimination was assessed using the area under the receiver operating characteristic (AUROC) curve. Calibration was assessed using calibration plots. Complete-case and imputed analyses were performed, and model risk scores were generated along with posttest probability. The RAM was validated in 4674 patients, with an AUROC of 0.71, a calibration slope of 1.0, and an intercept of 1.81 × 10−5. The AUROC for the imputed model was 0.69 with a calibration slope of 1.03 and an intercept of 1.22 × 10−3. Calculated risk scores were 1 or 2 for each variable in the RAM with a total risk score ranging from 0 to 6. The estimated probability of developing HA-VTE ranged from 1% to 17.4% depending on the total score. In conclusion, the CHAT-ICU RAM has good discriminatory validity, is well calibrated, and reliably identifies children in the PICU at high and low risk of HA-VTE.
Article Details
Authors (43)
Julie Jaffray
1Department of Pediatrics, University of California, San Diego, San Diego, CA
Brian Branchford
3Versiti Medical Sciences Institute, Milwaukee, WI
Maua M. Alleyne
5Department of Pediatrics, Data Coordinating Center for Pediatric Multicenter Studies, Johns Hopkins All Children’s Institute for Clinical and Translational Research, St. Petersburg, FL
Ernest K. Amankwah
5Department of Pediatrics, Data Coordinating Center for Pediatric Multicenter Studies, Johns Hopkins All Children’s Institute for Clinical and Translational Research, St. Petersburg, FL
E. Vincent S. Faustino
7Department of Pediatrics, Yale School of Medicine, New Haven, CT
Neil A. Zakai
Anthony A. Sochet
9Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
Amy Stillings
1Department of Pediatrics, University of California, San Diego, San Diego, CA
Emily Krava
1Department of Pediatrics, University of California, San Diego, San Diego, CA
Guy Young
Children’s Hospital Los Angeles
Neil A. Goldenberg
5Department of Pediatrics, Data Coordinating Center for Pediatric Multicenter Studies, Johns Hopkins All Children’s Institute for Clinical and Translational Research, St. Petersburg, FL
Sanjay P Ahuja
Katherine Armstrong
Alexander Boucher
Chi Braunreiter
Shelley E Crary
James Cooper
Colleen Druzgal
John H Fargo
Kathleen Garland
Shveta Gupta
Julie A Jaffray
Christine Knoll
Nicole E Kucine
Riten Kumar
Lori Luchtman-Jones
Arash Mahajerin
Deanna Maida
Lynn M Malec
Marie Martinelli
Shalu Narang
Kristy Pahl
Arun R Panigrahi
Stephanie Prozora
Beverly Schaefer
Michael Silvey
Children's Mercy Hospital, Kansas City, Missouri, United States
Anthony Sochet
Anjali Subbaswamy
Courtney D Thornburg
Marcella D Torres
Allison Wheeler
Gary M Woods
Jordan M Wright