Venous thromboembolism in pediatric traumatic brain injury: A systematic review and meta-analysis.

BACKGROUND: Venous thromboembolism (VTE) is a serious under-recognized complication in pediatric patients with traumatic brain injury (TBI). Understanding VTE frequency and risk factors is fundamental for prevention. The objective of this systematic review was to determine VTE frequency and risk factors in pediatric patients with TBI. METHODS: PubMed, Embase, Scopus, Web of Science, Google Scholar, The Cochrane Library, ClinicalTrials.gov, and WorldCat were systematically searched through June 2025. Peer-reviewed studies that reported on VTE frequency, risk factors, or chemoprophylaxis use in pediatric patients with moderate or severe TBI were eligible for inclusion. Two reviewers independently screened studies and assessed risk of bias. Data were extracted by one reviewer and verified by another. VTE frequency was estimated using a random-effects model; subgroup analyses and mixed-effects meta-regression explored effect modifiers. Evidence on risk factors and chemoprophylaxis was synthesized narratively. The protocol was registered in PROSPERO (CRD42024570459). RESULTS: Twenty-nine studies were included; 20 studies in patients with severe TBI (n=64,215, mean age 14.1 y) were pooled for meta-analysis. VTE frequency was 7% (95% CI: 4.4%-10.2%). Frequency was higher in patients with central venous lines (20%). Risk factors included injury severity and multimodality TBI treatment. Heterogeneity in study designs limits the interpretability of the results. Inconsistent VTE surveillance and the predominance of registry-based studies may have led to underestimation of VTE frequency. CONCLUSIONS: Pediatric patients with severe TBI seem to be at substantial risk of VTE, particularly when they undergo multimodality treatment. Prospective studies with standardized VTE surveillance are urgently needed. LEVEL OF EVIDENCE: Level III, systematic review and meta-analysis.