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.