Venous thromboembolism in children with lower limb fractures: A systematic review and meta-analysis.

OBJECTIVES: There is limited evidence regarding Venous Thromboembolism (VTE) in children with lower limb fractures. Our primary objective was to assess the rate, risk factors, mortality and role of pharmacological prophylaxis of VTE in children with lower limb fractures.

METHODS: Systematic review and meta-analysis. PubMed, CINAHL, and Cochrane CENTRAL were searched. Full published studies reporting on the rate of venous thromboembolism and/or on the efficacy of chemical thromboprophylaxis in children with lower limb fractures. Data extraction and quality appraisal were performed. Meta-analysis was conducted using a random effects model. The protocol was prospectively registered with PROSPERO (CRD42021278566).

RESULTS: Literature search identified 8342 articles of which 8 were included. All included studies were retrospective and studied paediatric populations in the USA and China. Meta-analysis of 5 studies reporting on children aged equal to or less than 18 years showed an overall estimated VTE rate of 0.53% (95%CI 0.20-1.38). There was sparse evidence related to risk factors for VTE and mortality rates in this patient population, and no evidence related to the impact of VTE prophylaxis.

CONCLUSIONS: VTE is a recognised occurrence in children with lower limb fractures, but it is estimated to be infrequent. There is a need for high-quality research to further evaluate the rates of VTE in subgroups of paediatric patients as well as to determine the risk factors, mortality and efficacy of pharmacological prophylaxis. Individualised assessment and management is recommended in the meantime.

LEVEL OF EVIDENCE: Level III, systematic review of Level III retrospective studies.