Screening and diagnosis of severe trauma of the lower limbs in children

ZHOU Hong-yan; ZUO Yu-ming; WANG Yue-guang; ZHAO Hong-bo; ZHANG Wen-long

doi:10.3969/j.issn.2095-252X.2017.11.013

Abstract：Objective To investigate the characteristics of post-trauma deep venous thrombosis ( DVT ) and pulmonary embolism ( PE ) in children, including screening, prevention, diagnosis and treatment strategies. Methods From January 1st, 2010 to December 30th, 2015, 3214 pediatric patients ( 1635 lower extremities ) were confirmed by Color Doppler ultrasound, Dynamic monitoring of D-dimer, and CT examination of intravenous contrast. Fourteen cases with DVT were found. For those with high-risk of DVT, basic prevention, physical prevention and drug prevention measures were conducted. All patients received anticoagulant treatment. Results The incidence rate of DVT was 0.44% in post-trauma children, while 0.86% in children with lower extremity trauma. It occurred 1 -6 days after the injury with the mean age of 14.5 years ( range: 7 - 16 years ). No pulmonary embolism occurred. All diagnosed DVT children were of lower extremity trauma or severe multiple injuries. Characteristics of DVT in children included short duration, quick disappearance, simple treatment, shorter course of treatment than that in adults, lower rate of recurrence and thrombus syndrome sequel. Conclusions DVT and PE in children are different comparing with adults in epidemiology, pathology, and physiology. So diagnosis and treatment should be individualized. In recent years, the morbidity has increased although it is lower than that in adults. Vigilance should be increased for at-risk children, especially for those with severe trauma of the lower limbs. Effective diagnosis, prevention and treatment of DVT are conducive to reduce the occurrence of venous thromboembolism.