TOPLINE

In hospitalized children and adolescents, venous thromboembolism (VTE) was linked to substantial care demands, with nearly a quarter of patients being infants younger than 1 year. Children aged 4 years or younger had the highest economic burden and more than triple the risk for in-hospital mortality compared with adolescents aged 15-19 years.

METHODOLOGY

• Researchers analyzed nationwide inpatient data from Germany from 2020 to 2024, identifying 14,108 patients (mean age, 9.0 years; 51.0% male) with VTE as the main or secondary diagnosis.
• VTE was defined as deep vein thrombosis (DVT; occurring in various anatomic locations), including catheter-associated thrombosis and pulmonary embolism (PE), with a subcohort of 888 patients in whom PE was the main diagnosis.
• The main outcomes assessed were in-hospital mortality and complications such as acute cor pulmonale, heart failure, resuscitation, and major bleeding.
• Assessments were based on predisposing risk factors for VTE as well as sex and age groups. The risk factors assessed included cancer, thrombophilia, obesity, heart failure, chronic kidney disease, sepsis, and others.

TAKEAWAY

• Overall, 23.5% of the patients with VTE were infants younger than 1 year, and 92.4% of VTE cases were associated with DVT alone. PE was recorded as the main or secondary diagnosis in 11.1% of patients, with a higher proportion of patients with PE recorded among female patients than among male patients (13.7% vs 8.6%; P < .001).
• Risk factors independently linked to the occurrence of PE were obesity (odds ratio [OR], 2.80; P < .001), heart failure (OR, 2.25; P < .001), COVID (OR, 1.68; P <.001), thrombophilia (OR, 1.31; P = .004), and female sex (OR, 1.28; P < .001).
• In-hospital mortality in the VTE cohort was 3.7%; the risk for mortality was increased among children aged 4 years or younger (OR, 3.52; P < .001) and among those with conditions such as kidney failure (OR, 2.38; P < .001), heart failure (OR, 2.84; P < .001), and sepsis (OR, 3.50; P < .001). The presence of PE was associated with an increased risk for in-hospital mortality in those with VTE (OR, 3.54; P < .001).
• The mean length of hospital stay was 20.5 days for the VTE cohort and 6.3 days for patients with a primary diagnosis of PE. The mean cost per inpatient VTE case was €19,684, with particularly high expenses of €33,854 per case for patients aged 4 years or younger.

IN PRACTICE

“Given the sparse data available, there is a need for appropriate studies to provide evidence-based support for the safety and effectiveness of medical interventions for children and adolescents with VTE,” the authors of the study wrote.

SOURCE

The study was led by Sabrina Friebe, PhD, Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany. It was published online on June 9, 2026, in JAMA Network Open.

LIMITATIONS

The analysis only included cases where patients received care in the hospital. Cases were identified using diagnostic codes, which might be inaccurate. Complete information on pharmacotherapy was not included in the database.

DISCLOSURES

The Open Access Publishing Fund of Leipzig University provided support for the study. One author disclosed receiving consultant fees from various sources, and another author disclosed receiving grants from the Federal Joint Committee during the conduct of the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.