Comparative validation study of risk assessment models for pediatric hospital-acquired venous thromboembolism

Arash Mahajerin; Julie Jaffray; Brian Branchford; Amy Stillings; Emily Krava; Guy Young; Neil A Goldenberg; E Vincent S Faustino

doi:10.1111/jth.14697

Comparative validation study of risk assessment models for pediatric hospital-acquired venous thromboembolism

J Thromb Haemost. 2020 Mar;18(3):633-641. doi: 10.1111/jth.14697. Epub 2019 Dec 22.

Authors

Arash Mahajerin¹, Julie Jaffray², Brian Branchford³, Amy Stillings⁴, Emily Krava⁴, Guy Young⁵, Neil A Goldenberg^{6

7}, E Vincent S Faustino⁸

Affiliations

¹ Division of Hematology, CHOC Children's Specialists, Orange, CA, USA.
² Division of Hematology, Oncology, BMT, Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
³ Department of Pediatrics, Section of Cancer and Blood Disorders, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
⁴ Children's Hospital Los Angeles, Los Angeles, CA, USA.
⁵ Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
⁶ Departments of Pediatrics and Medicine (Hematology), Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁷ Johns Hopkins All Children's Hospital, Johns Hopkins All Children's Institute for Clinical and Translational Research, , St. Petersburg, FL, USA.
⁸ Section of Pediatric Critical Care, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.

PMID: 31808292
DOI: 10.1111/jth.14697

Abstract

Background: Risk assessment models (RAMs) have been developed to identify children at high risk of hospital-acquired venous thromboembolism (HA-VTE). None have been externally validated nor compared.

Objectives: The objective was to compare performance of these RAMs by externally validating them using the Children's Hospital-Acquired Thrombosis (CHAT) Registry, ie, a multicenter database of children with radiographic-confirmed HA-VTE and corresponding controls.

Patients/methods: Risk assessment models were included if the full logistic regression equation was available and all RAM variables were collected in the CHAT Registry. A random sample of 200 cases and 200 controls was selected. The performance of the RAMs was assessed for discrimination using area under the receiver operating characteristic curves (AUROC), and calibration using plots, slopes, and intercepts, and the Hosmer-Lemeshow test.

Results: Three RAMs were included. Each had excellent discrimination with AUROC ≥ 0.85. However, calibration was generally poor, with calibration slopes significantly different from 1 (0.71, P < .001; 1.44, P = .002; 0.68, P < .001), intercepts significantly different from 0 (-1.64, P < .001; -0.62, P < .001; 0.78, P < .001), and Hosmer-Lemeshow test P < .001 for each. Exceptions included the Arlikar et al and Atchison et al RAMs for pediatric HA-VTE in non-intensive care unit (ICU) patients and ICU patients, respectively, despite derivation from ICU and non-ICU patients, respectively. In these subpopulations, both showed excellent discrimination and good calibration.

Conclusion: Given the lack of adequate calibration for evaluated RAMs, further investigation and refinement of RAMs for pediatric HA-VTE is needed prior to application of a RAM in a clinical setting or risk-stratified clinical trial of primary thromboprophylaxis against HA-VTE in children.

Keywords: pediatrics; risk assessment; risk factors; validation studies; venous thromboembolism.

Publication types

Multicenter Study
Validation Study

MeSH terms

Anticoagulants
Child
Hospitals, Pediatric
Humans
Risk Assessment
Risk Factors
Venous Thromboembolism* / diagnosis
Venous Thromboembolism* / epidemiology

Substances

Anticoagulants