Patterns and Growth of a Dedicated Pediatric Coagulation Consult Service in a Freestanding Children’s Hospital

Introduction: At our freestanding pediatric hospital, a dedicated inpatient coagulation consult service has existed for 15 years. To our knowledge, this type of service is relatively unique in a pediatric hospital and provides an opportunity to objectively evaluate changes in coagulation consults in this patient population. Over the past decade, the increasing rate of thrombosis in hospitalized pediatric patients has been noted and more attention has been placed on preventing the occurrence of hospital-acquired venous thromboembolism. With concern over this increased incidence, more inpatients have been receiving prophylactic anticoagulation.

Methods: This is a secondary use of existing clinical care data study, involving review of the patients receiving a consult from the inpatient coagulation consult service. Average daily census was documented via a clinical tracking system. Data collection ranged from May 2011 to May 2020. Since 2013, number of distinct new consults (not repeat patients), and indication for consult have also been documented. These data were analyzed for trends in average census number and indication for consult. Additionally, the service requesting the consult is also reported.

Results: From May 2011 to May 2020, the average daily census for the coagulation consult service has increased from 4.5 to 34.4 patients. (Figure 1) The rate of consult request for prophylactic anticoagulation increased from 8 in 2013 to 82 in 2020, while thrombosis and bleeding referrals remained relatively stable. (Figure 2) Since 2013, the service with the most requests for prophylactic anticoagulation over the entire period was orthopedic surgery with 70, followed by the cardiovascular intensive care (31) and medical intensive care (28) units (ICU). There was an increase in the number of prophylactic anticoagulation consults from the ICUs over the course of the study. (Figure 3) In early 2020 a VTE risk stratification was instituted in the CVICU.

Conclusions: In this single institution, retrospective study, we noted an increase in number of consults for the coagulation service overall, and a larger increase in requests for consults for prophylactic anticoagulation. Further studies should be done to determine whether this increase in use of prophylactic anticoagulation exists at other pediatric hospitals and the impact on subsequent VTE development.