IVC filter placements in children: nationwide comparison of practice patterns at adult and children's hospitals using the Kids' Inpatient Database.

ABSTRACT

BACKGROUND: Inferior vena cava (IVC) filter placement in children has been described in literature, but there is variability with regard to their indications. No nationally representative study has been done to compare practice patterns of filter placements at adult and children's hospitals. OBJECTIVE: To perform a nationally representative comparison of IVC filter placement practices in children at adult and children's hospitals. MATERIALS AND METHODS: The 2012 Kids' Inpatient Database was searched for IVC filter placements in children <18 years of age. Using the International Classification of Diseases, 9th Revision (ICD-9) code for filter insertion (38.7), IVC filter placements were identified. A small number of children with congenital cardiovascular anomalies codes were excluded 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. RESULTS: A total of 618 IVC filter placements were identified in children <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<0.001). 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. CONCLUSION: The majority of IVC filters in children are placed in adult hospital settings. Children's hospitals are more likely to place therapeutic filters for venous thromboembolism, compared to adult hospitals where the prophylactic setting of trauma predominates.