Screening ultrasound for deep vein thrombosis detection in high-risk pediatric trauma

Infographic · Jun 2025 · 1 min read

In brief

Multi-center study of 460 high-risk pediatric trauma patients found that screening ultrasound at 7 days post-injury detected asymptomatic DVT in 15.6% of patients, with 90% associated with central lines. Most DVTs occurred in patients without timely chemical prophylaxis, though clinical significance of asymptomatic detection remains unclear.

Screening ultrasound at 7 days post-injury detected DVT in 15.6% of high-risk pediatric trauma patients, mostly asymptomatic.
90% of detected DVTs were associated with central venous lines, highlighting catheter-related thrombosis risk.
DVTs occurred more frequently when chemical prophylaxis was delayed >24 hours or not given at all.
Most DVTs in high-risk pediatric trauma occur within the first week of injury.
Clinical significance of asymptomatic DVT detection by screening ultrasound remains uncertain.

Written by the GCMD Library team from the infographic.

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Amanda B. Witte, Kyle Van Arendonk, Richard A. Falcone Jr., Suzanne Moody, Heather A. Hartman, Emily Evans, Rajan Thakkar, Kelli N. Patterson, Peter C. Minneci, Grace Z. Mak, Mark B. Slidell, MacKenton Johnson, Matthew P. Landman, Troy A. Markel, Charles M. Leys, Linda Cherney Stafford, Jessica Draper, David S. Foley, Cynthia Downard, Tracy M. Skaggs, Dave R. Lal, Peter F. Ehrlich & David Gourlay

Purpose: Venous thromboembolism (VTE) is a rare but significant complication among high-risk pediatric trauma patients. The NO CLOT study’s primary aim was to evaluate the safety of chemical prophylaxis against VTE in high-risk pediatric trauma patients with a secondary aim of evaluating the use of screening venous duplex ultrasound (sUS) to identify deep vein thrombosis (DVT). We hypothesized that sUS would detect asymptomatic DVT at a high rate in high-risk patients.

Methods: A prospective multi-institutional study was performed at eight level one pediatric trauma centers from 2019 to 2022. sUS was recommended 7 days after admission for all high-risk trauma patients. Univariate and multivariate analyses were performed.

Results: Of 460 high-risk trauma patients, 64/341 (18.8%) remained admitted on day 7 and underwent sUS. Ten of 64 (15.6%) had a DVT identified on sUS (median of 6.5 [IQR 5.2, 7.0] days after trauma). In 277 patients still admitted on day 7 without sUS performed, 15 (5.4%) developed symptomatic DVT (median of 6.0 [IQR 3.0, 8.0] days after trauma. For the sUS cohort, 9/10 (90%) DVTs were associated with an indwelling central venous line (CVL) and occurred either without chemical prophylaxis use at all in 4/10 (40%) or when initiated more than 24-h post-trauma in 6/10 (60%).

Conclusions: In this high-risk cohort, most DVTs were identified in the first week following injury; however, the majority were asymptomatic. Use of sUS at 1-week post-injury increases DVT detection; however, the clinical consequences of asymptomatic detection of DVT remain unknown.

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