{
  "abstract": "Background: Venous thromboembolism (VTE), although uncommon in pediatric populations, occurs more frequently in hospitalized children. Robust, prospectively derived risk prediction models for symptomatic VTE remain limited in this setting. Aims: To identify independent risk factors for VTE and to develop a predictive model for symptomatic thrombosis in hospitalized pediatric patients. Methods: This prospective multicenter cohort study (September 2018–January 2022) evaluated 2,722 pediatric patients (birth–18 years) across 5,040 hospitalizations, identifying 39 imaging-confirmed symptomatic VTE cases (1.43%). A multivariable logistic regression model was built using forward selection to incorporate clinical and procedural predictors. Adjusted odds ratios (95% CI) and model discrimination (out-of-bag C-index) were validated using 50,000 BCa bootstrap resamples. Results: Among 5,040 pediatric hospitalizations, 39 patients developed VTE (0.77% incidence; median age 5.0 years, 45.9% female). Compared to non-VTE controls, patients with VTE had significantly higher rates of ICU admission (79.5% vs. 26.6%), central venous catheterization (69.2% vs. 29.8%), bed immobilization (76.9% vs. 37.4%), cardiovascular disease (17.9% vs. 3.0%), and neurological disease (12.8% vs. 3.2%; all p < 0.01). Furthermore, VTE was associated with a markedly prolonged median hospital stay (29.5 vs. 5.0 days, p < 0.001). Increasing age was associated with higher risk (aOR 1.07 per year; 95% CI, 1.03–1.12), as were intensive care unit admission (aOR 1.91; 95% CI, 1.42–2.66) and longer length of hospitalization (aOR 1.01 per day; 95% CI, 1.01–1.02). Procedural factors showed the strongest associations with thrombosis, including 2≥ catheter insertion attempts (aOR 6.47; 95% CI, 2.81–14.49), femoral venous catheter (aOR 28.22; 95% CI, 7.23–90.36), and cervicothoracic venous catheter (aOR 4.71; 95% CI, 2.84–7.94). The final model demonstrated strong discriminative performance, with a C-index of 0.90 (95% CI, 0.83–0.97), sensitivity of 0.85, specificity of 0.78, and a negative predictive value of 0.99. Risk factors for symptomatic pediatric thrombosis were evaluated using multivariable logistic regression (forward selection with 50,000 BCa bootstrap resamples) alongside ten machine learning (ML) algorithms (70/30 train–test split, 10-fold cross-validation, and SHAP explainability analysis). Both statistical modeling and ML approaches independently converged on the exact same clinical and procedural predictors, confirming the biological and clinical validity of the identified risk drivers. Discussion: Aligning with prior literature, the use of femoral access and insertion attempts are likely mediated by mechanical endothelial disruption, flow turbulence, catheter mechanical distress, and emergency access placement. Targeted protocols aiming to minimize catheter manipulation and avoid high-risk sites like the femoral vein are essential for VTE prevention. Conclusion: Symptomatic VTE in hospitalized children is strongly influenced by modifiable procedural and clinical factors. This predictive model shows high discriminative performance and may support individualized risk stratification and targeted thromboprophylaxis strategies in pediatric inpatient care – after external validation and clinical impact assessment. Approved by Ethics Committee of UNICAMP (CAAE: 87364418.2.1001.5404). Supported by FAPESP (#2016/14172-6).",
  "abstract_shown": true,
  "affiliations": [
    "Centro de Hematologia e Hemoterapia (Hemocentro), Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil",
    "Faculdade de Engenharia Química, Laboratório de Otimização, Projeto e Controle Avançado, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil",
    "Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil",
    "Centro Infantil Boldrini, Campinas, Brazil",
    "Departamento de Engenharia Química, Instituto de Ciências Ambientais, Químicas e Farmacêuticas, Universidade Federal de São Paulo (UNIFESP), Diadema, Brazil",
    "Department of Medicine (DIMED), University of Padua, Italy",
    "The Hospital for Sick Children, University of Toronto, Canada"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Stephany Cares HUBER"
    },
    {
      "affs": [
        1
      ],
      "name": "Mohamad Al BANNOUD"
    },
    {
      "affs": [
        0
      ],
      "name": "Silmara Aparecida de Lima MONTALVÃO"
    },
    {
      "affs": [
        0
      ],
      "name": "Sandra Martins SILVA"
    },
    {
      "affs": [
        2
      ],
      "name": "Sumara Zuanazi Pinto RIGATTO"
    },
    {
      "affs": [
        2
      ],
      "name": "Ricardo Onofre Benez VILELA"
    },
    {
      "affs": [
        0
      ],
      "name": "Arlindo Nascimento Lemos JUNIOR"
    },
    {
      "affs": [
        3
      ],
      "name": "Mônica Pinheiro de Almeida VERÍSSIMO"
    },
    {
      "affs": [
        4
      ],
      "name": "Tiago Dias MARTINS"
    },
    {
      "affs": [
        1
      ],
      "name": "Gabriel Yoshiaki OTTAIANO"
    },
    {
      "affs": [
        1
      ],
      "name": "Rubens Maciel FILHO"
    },
    {
      "affs": [
        5
      ],
      "name": "Walter AGENO"
    },
    {
      "affs": [
        6
      ],
      "name": "Leonardo Rodrigues BRANDÃO"
    },
    {
      "affs": [
        0
      ],
      "name": "Joyce Maria ANNICHINO-BIZZACCHI"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0r6anhnke11ej.bib",
  "cited_by": 0,
  "doi": "10.1016/j.htct.2026.108077",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2531137926018249",
  "id": "0r6anhnke11ej",
  "issns": [
    "2531-1379",
    "2531-1387"
  ],
  "landing_url": "https://doi.org/10.1016/j.htct.2026.108077",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC633-647.5"
    ],
    [
      "openalex",
      "2724|Venous Thromboembolism Diagnosis and Management"
    ]
  ],
  "openalex": "W7223129611",
  "pdf_url": "https://www.sciencedirect.com/science/article/pii/S2531137926018249/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-23",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/0r6anhnke11ej.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:43:27Z",
      "native_id": "9915c72fbed6404ab6746d896484bb86",
      "source": "doaj",
      "url": "https://doi.org/10.1016/j.htct.2026.108077"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:RC633-647.5",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "CLINICAL AND PROCEDURAL PREDICTORS OF THROMBOSIS IN HOSPITALIZED CHILDREN",
  "title_text": "CLINICAL AND PROCEDURAL PREDICTORS OF THROMBOSIS IN HOSPITALIZED CHILDREN",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:43:27Z",
  "url": "https://research.draconitic.com/paper/0r6anhnke11ej",
  "venue": "Hematology, Transfusion and Cell Therapy",
  "versions": []
}