Pediatric venous thromboembolism (VTE) is a condition increasingly encountered by emergency medicine physicians. Unfortunately, despite increased incidence, the diagnosis of pediatric VTE relies on a high index of suspicion from clinicians. Delays in diagnosis and initiation of treatment can lead to poor outcomes in children, including an increased risk of mortality from pulmonary embolism, increased risk of VTE recurrence, and the development of the post-thrombotic syndrome. The majority of pediatric VTE events are associated with the presence of at least one underlying prothrombotic risk. Timely recognition of these risk factors in the emergency department (ED) setting is paramount for a prompt diagnosis and treatment initiation. Compared with children with hospital-acquired VTE, children presenting to the ED with new onset VTE tend to be older (>11 years of age), have a lower incidence of co-morbidities, and present more frequently with a deep venous thrombosis of the lower extremity. Currently, there are no validated pediatric-specific VTE clinical pretest probability tools that reliably assist with the accurate and timely diagnosis of pediatric VTE. Compression ultrasound with Doppler is the most common imaging modality used for VTE diagnosis, and low molecular weight heparins are the most common anticoagulants initiated in children presenting with VTE in the ED. Special consideration should be given to patients who present to the ED already on anticoagulation therapy who may require acute management for clinically-significant bleeding or change in antithrombotic therapy approach for progression/recurrence of VTE.

小儿静脉血栓栓塞症 (VTE) 是急诊医师越来越多地遇到的一种疾病。不幸的是，尽管发病率有所增加，但儿科 VTE 的诊断依赖于临床医生的高度怀疑。延误诊断和开始治疗可能导致儿童预后不良，包括肺栓塞死亡风险增加、静脉血栓栓塞复发风险增加以及血栓形成后综合征的发生。大多数儿科 VTE 事件与存在至少一种潜在的促血栓形成风险相关。在急诊室 (ED) 环境中及时识别这些风险因素对于迅速诊断和治疗开始至关重要。与医院获得性 VTE 的儿童相比，新发 VTE 到急诊室就诊的儿童往往年龄较大（>11 岁），合并症的发生率较低，并且更常出现下肢深静脉血栓形成。目前，没有经过验证的儿科特异性 VTE 临床前测概率工具可以可靠地帮助准确和及时地诊断儿科 VTE。多普勒压缩超声是用于 VTE 诊断的最常用成像方式，低分子肝素是急诊科出现 VTE 的儿童最常用的抗凝剂。应特别考虑到急诊室就诊的已接受抗凝治疗的患者，这些患者可能需要对有临床意义的出血进行紧急处理或改变抗血栓治疗方法以应对 VTE 的进展/复发。