ABSTRACT
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. Aim(s): To identify areas for improvement of thromboprophylaxis recommendations for children admitted to hospital with COVID-19. Method(s): Inpatients with a positive COVID-19 PCR test on admission (or within 24 h) 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. Result(s): Of the 375 inpatients with COVID-19 who underwent thromboprophylaxis screening, 43 were excluded as their COVID-19 was performed >24 h 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.