Strengths and Limitations
Despite the observed lack of efficacy in this study, strengths of the study include its originality as, to our knowledge, the first large pediatric study to demonstrate the use of a randomization tool integrated into the EMR to provide unbiased, automated randomization for more 17 000 patients. Furthermore, the model was updated with new EMR information daily throughout each patient’s admission, which may contribute to the slightly different We acknowledge the following limitations. First, although randomization and calculation of HA-VTE risk was automated in the EMR, subsequent manual review by the study team was only performed on weekdays; therefore, patients were randomized to the intervention who had elevated risk but were not reviewed. These patients were included in the intervention group in the primary intention-to-treat analysis but were not included in the as-treated analysis; both analyses failed to show benefit of the intervention. Second, while this study was only performed at a single site, we have successfully demonstrated the ability of an automated prognostic model incorporated into the EMR to accurately identify patients at elevated risk, which we are actively working to expand to additional academic children’s hospitals, which may have different baseline rates of HA-VTE due to demographic variability and different strategies for pharmacologic thromboprophylaxis, mobilization, and CVL removal.