Nationwide Practice Patterns Studied for IVC Filter Placement in Children
March 7, 2018—Findings from a nationwide comparison of practice patterns in inferior vena cava (IVC) filter placement in children at adult and children's hospitals were published by Vibhor Wadhwa, MD, et al in Pediatric Radiology (2018;48:253–257).
The background of the study is that IVC filter placement in children has been described in the literature, but there is variability with regard to their indications; additionally, no nationally representative study has been done to compare practice patterns of filter placements at adult and children's hospitals.
The investigators used the 2012 Kids' Inpatient Database to search for IVC filter placements in children younger than 18 years. IVC filter placements were identified using the ICD-9 code for filter insertion (38.7).
The study excluded a small number of children with congenital cardiovascular anomaly codes to improve specificity of the code used to identify filter placement. Filter placements were further classified by patient demographics, hospital type (children's and adult), United States geographic region, urban/rural location, and teaching status. Statistical significance of differences between children's or adult hospitals was determined using the Wilcoxon rank sum test.
As summarized in Pediatric Radiology, a total of 618 IVC filter placements were identified in children younger than 18 years (367 males, 251 females; age range, 5–18 years) during 2012. The majority of placements occurred in adult hospitals (573/618; 92.7%). Significantly more filters were placed in the setting of venous thromboembolism in children's hospitals (40/44; 90%) compared to adult hospitals (246/573; 43%) (P < .001). Prophylactic filters comprised 327/573 (57%) at adult hospitals, with trauma being the most common indication (301/327; 92%). The mean length of stay for patients receiving filters was 24.5 days in children's hospitals and 18.4 days in adult hospitals.
The majority of IVC filters in children are placed in adult hospital settings; however, children's hospitals are more likely to place therapeutic filters for venous thromboembolism, compared to adult hospitals where the prophylactic setting of trauma predominates, concluded the investigators in Pediatric Radiology.
Discussing the findings with Endovascular Today, Dr. Wadhwa commented, "IVC filters are potentially life-saving devices, but given the long-term complications associated with them, they must be used cautiously in the pediatric age group."