ABSTRACT
BACKGROUND: The incidence of venous thrombo-embolism (VTE) in hospitalized children has increased by 130%-200% over the last two decades. Given this increase, many centers utilize electronic clinical decision support (CDS) to prognosticate VTE risk and recommend prophylaxis. SARS-CoV-2 infection (COVID-19) is a risk factor for VTE; however, CDS developed before the COVID-19 pandemic may not accurately prognosticate VTE risk in children with COVID-19. This study's objective was to identify areas to improve thromboprophylaxis recommendations for children with COVID-19. METHODS: Inpatients with a positive COVID-19 test at admission were identified at a quaternary-care pediatric center between March 1, 2020 and January 20, 2022. The results of the institution's automated CDS thromboprophylaxis recommendations were compared to institutional COVID-19 thromboprophylaxis guidelines and to the actual thromboprophylaxis received. CDS optimization was performed to improve adherence to COVID-19 thromboprophylaxis recommendations. RESULTS: Of the 329 patients included in this study, 106 (28.2%) were prescribed pharmaco-prophylaxis, 167 (50.8%) were identified by the institutional COVID-19 guidelines as requiring pharmaco-prophylaxis, and 45 (13.2%) were identified by the CDS as needing pharmaco-prophylaxis. On univariate analysis, only age 12 years or more was associated with recipient of appropriate prophylaxis (OR 1.78, 95% CI: 1.13-2.82, p = .013). Five patients developed VTEs; three had symptoms at presentation, two were identified as high risk for VTE by both the automated and best practice assessments but were not prescribed pharmaco-prophylaxis. CONCLUSION: Automated thromboprophylaxis recommendations developed prior to the COVID-19 pandemic may not identify all COVID-19 patients needing pharmaco-prophylaxis. Existing CDS tools need to be updated to reflect COVID-19-specific risk factors for VTEs.
Subject(s)
COVID-19 , Venous Thromboembolism , Humans , Child , Anticoagulants/therapeutic use , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control , Venous Thromboembolism/epidemiology , COVID-19/complications , Pandemics , SARS-CoV-2 , Hospitals , Risk FactorsABSTRACT
The restructured course was built upon a hybrid flipped model utilizing an online learning management system including active learning modules which provided a foundation of preparedness for transitioning to fully online course delivery. Content from this course applies to technology education curricula as well as individuals pursuing engineering degrees (International Technology and Engineering Educators Association [ITEEA], 2019;Meyers, 2000). Since the course is a requirement for engineering degree programs as well as the technology, engineering, and design education program, the sudden transition impacted 395 students enrolled in the course (six sections of 60 students and one section of 35 students). The course is designed to help students develop and refine their ability to use this universal technical language within the context of the concurrent engineering design process as well as gain an understanding of how computer-aided design (CAD) is used to create solid model objects that students use on a daily basis. Online course elements from the restructure for both asynchronous and synchronous models included content resources, portable document format (PDF) copies of content presentations, videos of content lectures, assignments submission, assessments, active learning modules, as well as CAD solid modeling practice.