A population based cohort study: the epidemiology of pediatric venous thromboembolism in Quebec, Canada
Notice bibliographique
Résumé
Background: Pediatric venous thromboembolism (VTE), although rare, is associated with significant morbidity and mortality. Published incidence and recurrence rates in children vary widely with incidence rates ranging from 0.07 to 0.49 VTE per 10 000 children/year and recurrence risks ranging from 5.5% to 18.5%. There is currently a paucity of studies evaluating temporal incidence trends, as well as risk factors for recurrence. Objectives: To describe the age-adjusted incidence rate of pediatric VTE and its trend over time, to determine VTE recurrence rate and overall all-cause mortality following VTE, and to determine predictors of VTE recurrence and all-cause mortality. Methods: A retrospective population-based cohort of all children (ages 1-17 inclusive) with a first time diagnosis of VTE in the province of Quebec between January 1st, 1994 and December 31st, 2004 was obtained from a comprehensive administrative hospital database (Med-Echo). Provincial census estimates were used to calculate age-standardized incidence rates (IR) of pediatric VTE. The incidence rate trend was then analyzed over the eleven-year study period using Poisson linear regression with time as both a continuous (yearly) and categorical (time periods) variable. Rate of VTE recurrence and all-cause mortality were determined. Univariate Cox-proportional hazards models and log rank testing were used to assess which risk factors would be incorporated into the final multivariate Cox-proportional hazards model evaluating risk of VTE recurrence and all-cause mortality. Results: In total, 487 incident cases of VTE in children 1-17 years of age were documented. Based on the estimated provincial census person-years during the study period, the age-standardized IR was 0.29 VTE per 10 000 person-years (95% confidence interval (CI) 0.26-0.31). Females had a statistically significant higher VTE incidence rate (per 10 000 person-years) than males, 0.37 and 0.21 per 10 000 person-years, respectively with an incidence rate ratio comparing females to males, adjusted for age group of 1.75 (95% CI 1.46-2.10). Trend analysis showed no statistically significant change in the age-standardized IRs over the 11-year period. The VTE recurrence rate was 2.77 (95% CI 2.2-3.4) per 1000 person-months (overall risk of 16%). Recurrence was associated with the presence of a chronic disease, defined as a diagnosis of inflammatory bowel disease, cystic fibrosis, lupus, sickle cell disease or nephrotic syndrome, (hazard ratio (HR) 2.3; 95% CI 1.2-4.3), presence of a central vascular line at time of initial VTE (HR 1.9; 95% CI 1.0-3.3) and portal vein thrombosis as the initial VTE presentation (HR 4.1; 95% CI 1.5-11.0). Overall all-cause mortality was 6.4%, hazard modeling of known risk factors for VTE was inconclusive for mortality. Conclusions: Pediatric VTE is more frequent than previously described, however its incidence appears to be stable over time. Females are more prone to VTE than males in this age group. Risk of recurrence in our cohort is at the higher end of previously reported values, and is higher in those with a pre-existing chronic illness, central vascular line or with an initial diagnosis of portal vein thrombosis. All-cause mortality was lower in our cohort than previous large studies of VTE in this age group. Our findings highlight the need for future studies to address sex differences in the incidence of pediatric VTE to help determine effective primary thromboprophylaxis strategies in children at high risk for VTE, as well as determine effective secondary prophylaxis strategies in children at high risk for VTE recurrence.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,005 |
| Études des sciences et des technologies | 0,002 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».