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Deep Venous Thrombosis (DVT) is a serious medical condition characterized by the formation of blood clots in the deep veins, most commonly occurring in the lower extremities. Traditionally, this condition has been associated with older adults; however, recent observations and studies have brought attention to the rising incidence of DVT among adolescents, especially those who are critically ill. This article delves into the epidemiology of lower extremity DVT in critically ill adolescents, shedding light on the prevalence, risk factors, clinical presentations, diagnostic techniques, and management strategies [1- 3]. Understanding these aspects is crucial for healthcare providers to provide timely and effective care to this vulnerable demographic .

I. Incidence and prevalence

In the past decade, there has been a noticeable increase in reported cases of lower extremity DVT in critically ill adolescents. This rise can be attributed to various factors, including an increase in pediatric intensive care admissions, advancements in diagnostic techniques, and a heightened awareness of the condition [4 - 6 ]. Studies indicate that the incidence of DVT in this demographic ranges from 0.5% to 5.3%, with a higher prevalence among adolescents admitted for conditions like trauma, sepsis, cancer, and those undergoing major surgeries [7- 9 ].

II. Risk factors

A. Immobility and prolonged hospitalization

• Critically ill adolescents often experience extended periods of immobility due to the severity of their condition or necessary postoperative recovery, predisposing them to DVT.

B. Central venous catheters (CVCS)

• The presence of CVCs increases the risk of DVT, especially when they are placed for extended durations.

C. Hypercoagulable states

• Certain underlying medical conditions such as malignancies, inherited thrombophilias, and systemic inflammatory disorders can contribute to a hypercoagulable state.

D. Trauma and surgery

• Adolescents undergoing major surgical procedures or those who have suffered trauma are at an increased risk due to endothelial injury and altered blood flow.

III. Clinical presentation

Recognizing the signs and symptoms of DVT in critically ill adolescents is crucial for early diagnosis and intervention. Common clinical presentations include:

A. Unilateral limb swelling and pain B. Tenderness or warmth over the affected area C. Red or discolored skin D. Engorged superficial veins (collateral vessels)

IV. Diagnosis

A. Ultrasound doppler

• The gold standard for diagnosing DVT, ultrasound Doppler can accurately identify the presence, location, and extent of the thrombus.

B. D-dimer assay

• While helpful in ruling out DVT in low-risk patients, elevated D-dimer levels are common in critically ill individuals, limiting its diagnostic value.

C. Venography and magnetic resonance venography (MRV)

• In specific cases, particularly when ultrasound results are inconclusive, venography or MRV may be employed to visualize the venous system.

V. Management and prevention

A. Anticoagulation therapy

• Heparin, low-molecular-weight heparin (LMWH), and warfarin are commonly used anticoagulants to prevent thrombus propagation.

B. Thrombolytic therapy

• In severe cases, where there is a risk of limb-threatening or life-threatening complications, thrombolytic therapy may be considered.

C. Inferior vena cava (IVC) filters

• In cases where anticoagulation is contraindicated or ineffective, an IVC filter may be placed to prevent emboli from reaching the pulmonary circulation.

D. Early mobilization and compression stockings

• Encouraging mobility and utilizing compression stockings can help reduce the risk of DVT in critically ill adolescents.

Conclusion

Lower extremity DVT in critically ill adolescents is an emerging clinical challenge, necessitating heightened awareness, early recognition, and prompt intervention. Through a comprehensive understanding of the epidemiology, risk factors, clinical presentation, and management strategies, healthcare providers can optimize care for this vulnerable population. Additionally, ongoing research is essential to further elucidate the underlying mechanisms and refine therapeutic approaches in this evolving field.

Acknowledgement

None

Conflict of Interest

None

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