1
|
彭 清, 刘 佳, 刘 焱, 尚 华, 唐 果, 韩 雅, 龙 丽. [Application of Padua prediction score and serum albumin level in evaluating venous thromboembolism in rheumatic inpatients]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2023; 55:625-630. [PMID: 37534642 PMCID: PMC10398766 DOI: 10.19723/j.issn.1671-167x.2023.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To investigate the status of venous thromboembolism (VTE) in rheumatic inpatients, and to explore the efficiency of Padua prediction score (PPS) in the patient population. In addition, to analyze the relationship between serum albumin and VTE in rheumatic inpatients. METHODS Data of inpatients with rheumatology were retrospectively collected and analyzed at Sichuan Provincial People's Hospital from September 2018 to September 2019. Occurrence of VTE was compared between high (PPS≥4) and low (PPS < 4) risk groups. PPS were analyzed in the VTE and non-VTE patients. Multivariate Logistic regression model was used to analyze the risk factors in PPS and the relationship between serum albumin and VTE. RESULTS A total of 1 547 patients were included in this study, and 27 (1.7%) had symptomatic VTE. Among the symptomatic VTE cases, 19 (1.2%) had deep vein thrombosis (DVT) only, 6 (0.4%) had pulmonary thromboembolism (PTE) only, and 2 (0.1%) were diagnosed with DVT and PTE. PPS in the VTE and non-VTE groups were 3.33±1.78 and 1.80±0.97 respectively (P < 0.05).The number of patients with PPS≥4 in the VTE group and non-VTE group was 37.0% and 4.3% respectively (P < 0.01). The average serum albumin level in the VTE group was lower than that in non-VTE group [(29.79±6.36) g/L vs. (35.17±6.31) g/L, P < 0.001]. Seventy-six cases was divided into high-risk group of VTE, while 1 471 cases were in the low-risk group, and the incidence of VTE was 13.2% and 1.2% respectively (P < 0.001). Logistic regression analysis showed that ongoing hormonal treatment, age≥70 years, trauma and/or surgery ≤30 d, reduced mobility and previous VTE were risk factors of VTE in the rheumatology patients, OR values were 7.11, 7.07, 3.40, 2.40 and 2.00, respectively. Lower serum albumin level was the risk factor of VTE in the rheumatology patients [OR=0.88 (95%CI: 0.82-0.94)]. CONCLUSION The incidence of VTE was relatively higher in the hospitalized patients in Department of Rheumatology and Immunology. Glucocorticoid therapy was the highest risk factor of VTE and lower serum albumin level also was the risk factor. Although the PPS can reflect the risk of VTE in rheumatic inpatients to some extent, its effectiveness is limited. PPS can be optimized for quantitative VTE risk assessment of rheumatic inpatients in the future.
Collapse
Affiliation(s)
- 清 彭
- 成都市第二人民医院风湿免疫科, 成都 610000Department of Rheumatology and Immunology, Chengdu Second People's Hospital, Chengdu 610000, China
- 遵义医科大学第一临床学院, 贵州遵义 563000Zunyi Medical University, Zunyi 563000, Guizhou, China
| | - 佳君 刘
- 遵义医科大学第一临床学院, 贵州遵义 563000Zunyi Medical University, Zunyi 563000, Guizhou, China
| | - 焱 刘
- 遵义医科大学第一临床学院, 贵州遵义 563000Zunyi Medical University, Zunyi 563000, Guizhou, China
| | - 华 尚
- 遵义医科大学第一临床学院, 贵州遵义 563000Zunyi Medical University, Zunyi 563000, Guizhou, China
| | - 果 唐
- 重庆市璧山区人民医院风湿免疫科, 重庆 402760Department of Rheumatology and Immunology, The Bishan Hospital of Chongqing, Chongqing 402760, China
| | - 雅欣 韩
- 成都市温江区人民医院风湿免疫科, 成都 610000Department of Rheumatology and Immunology, The Wenjiang Hospital of Chengdu, Chengdu 610000, China
| | - 丽 龙
- 遵义医科大学第一临床学院, 贵州遵义 563000Zunyi Medical University, Zunyi 563000, Guizhou, China
- 四川省人民医院风湿免疫科, 成都 610000Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, Chengdu 610000, China
| |
Collapse
|
2
|
Tao J, Lou F, Liu Y. The Role of Vitamin D in the Relationship Between Gender and Deep Vein Thrombosis Among Stroke Patients. Front Nutr 2021; 8:755883. [PMID: 34926545 PMCID: PMC8674815 DOI: 10.3389/fnut.2021.755883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/04/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction: Accumulating evidence had demonstrated that females had a higher risk of deep vein thrombosis (DVT) than males, but the mechanism was still unknown. Vitamin D was found to play an essential role in DVT, and gender may influence the serum vitamin D levels. This study aimed to explore whether vitamin D played a role in the gender difference in DVT. Materials and Methods: A total of 444 patients with acute stroke were recruited, which were divided into the DVT group (n = 222) and the non-DVT group (n = 222). Serum vitamin D levels were measured after admission and were split into three categories, including deficiency (<50 nmol/L), insufficiency (52.5–72.5 nmol/L), and sufficiency (more than 75 nmol/L). Hierarchical regression analysis was adopted to analyze the relationship between gender and DVT, controlling the confounding factors. Results: Females showed a higher proportion of DVT than males (60.7 vs. 42.5%, p < 0.001), and lower serum vitamin D levels than males (53.44 ± 16.45 vs. 69.43 ± 23.14, p < 0.001). Moreover, serum vitamin D levels were lower in the DVT group than in the non-DVT group (59.44 ± 19.61 vs. 66.24 ± 23.86, p < 0.001). Besides, the DVT group showed a lower proportion of vitamin D sufficiency than the non-DVT group (21.2 vs. 32.9%, p < 0.05). Hierarchical regression analysis showed that females had 2.083-fold (p < 0.001, unadjusted model) and 1.413-fold (p = 0.155, adjusted model) risk to develop DVT. In addition, the sufficiency status of vitamin D showed an independent protective effect on DVT (unadjusted model OR, 0.504, p = 0.004; adjusted model OR, 0.686, p = 0.011). Conclusion: Females had a higher risk of DVT than males, and vitamin D may play an essential role in this relationship. Further studies are needed to explore whether vitamin D supplementation could reduce DVT risk in stroke patients, especially females.
Collapse
Affiliation(s)
- Jiejie Tao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Feiling Lou
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuntao Liu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
3
|
Mugeni R, Nkusi E, Rutaganda E, Musafiri S, Masaisa F, Lewis KL, Simpao M, Tugirimana PL, Walker TD. Proximal deep vein thrombosis among hospitalised medical and obstetric patients in Rwandan university teaching hospitals: prevalence and associated risk factors: a cross-sectional study. BMJ Open 2019; 9:e032604. [PMID: 31772101 PMCID: PMC6887052 DOI: 10.1136/bmjopen-2019-032604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To determine the prevalence of proximal deep vein thrombosis (DVT) by ultrasound scanning, as well as associated clinical features and known risk factors, among medical and obstetrics-gynaecology inpatients in two Rwandan tertiary hospitals. DESIGN Cross-sectional study. SETTINGS Rwanda teaching hospitals: Kigali and Butare University Teaching Hospitals. PARTICIPANTS 901 adult patients admitted to the Departments of Internal Medicine and Obstetrics-Gynecology (O&G) who were at least 21 years of age and willing to provide a consent. OUTCOMES Prevalence of proximal DVT, clinical features and known risk factors associated with DVT. METHODS Between August 2015 and August 2016, participants were screened for DVT by compressive ultrasound of femoral and popliteal veins, conducted as a monthly cross-sectional survey of all consenting eligible inpatients. Patients completed a self-report survey on DVT risk factors. Prevalence of proximal DVT by compression ultrasonography was the primary endpoint, with univariate and multivariate regression analyses performed to assess associated clinical features and risk factors. RESULTS Proximal DVT was found in 5.5% of the study population, with similar rates in medical and O&G inpatients. The mean age was 41±16 SD (range, 21-91), 70% were female and 7% were pregnant. Univariate analysis showed active malignancy, immobilisation, prolonged recent travel and history of DVT to be significant risk factors for proximal DVT (all p values <0.05); while only active malignancy was an independent risk factor on multivariate regression (OR 5.2; 95% CI 2.0 to 13). Leg pain or tenderness, increased calf circumference, unilateral limb swelling or pitting oedema were predictive clinical features of DVT on both univariate analysis and multivariate regression (all p values <0.05). CONCLUSION Proximal DVT prevalence is high among hospitalised medical and O&G patients in two tertiary hospitals in Rwanda. For reducing morbidity and mortality, research to develop Africa-specific clinical prediction tools for DVT and interventions to increase thromboprophylaxis use in the region are urgently needed.
Collapse
Affiliation(s)
- Regine Mugeni
- Internal Medicine, Rwamagana Hospital, Rwamagana, Eastern, Rwanda
| | - Eugene Nkusi
- Internal Medicine, Butaro Hospital, Burera, Northern, Rwanda
| | - Eric Rutaganda
- Internal Medicine, Centre Hospitalier Universitaire de Kigali, Kigali City, Rwanda
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Sanctus Musafiri
- Internal Medicine, Centre Hospitalier Universitaire de Kigali, Kigali City, Rwanda
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Florence Masaisa
- Internal Medicine, Centre Hospitalier Universitaire de Kigali, Kigali City, Rwanda
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Kayan Lea Lewis
- School of Public Health, University of Texas, Houston, Texas, USA
| | - Marc Simpao
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | | | - Timothy David Walker
- Internal Medicine, Calvary Mater Newcastle, Hunter Region Mail Centre, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| |
Collapse
|
4
|
Perception of Thromboembolism Risk: Differences between the Departments of Internal Medicine and Emergency Medicine. Keio J Med 2016; 65:39-43. [PMID: 27349662 DOI: 10.2302/kjm.2015-0004-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The latest developments in emergency medicine (EM) have introduced new typologies of patients that have not been taken into account in previous studies of venous thromboembolism (VTE) risk. The aim of the current study was to evaluate by comparing the main international risk scores whether different perceptions of VTE risk exist in internal medicine (IM) departments and in EM departments. This cross-sectional observational study involved 23 IM and 10 EM departments of 21 different hospitals. The patient data were collected by physicians who were blinded to the purpose of the study. The data were analyzed using the main international risk scores. We analyzed 742 patients, 222 (30%) hospitalized in EM departments and the remaining 520 (70%) in IM departments. We found that fewer patients at risk for VTE were treated with low-molecular-weight heparin (LMWH) in EM departments than in IM departments. Moreover, there was significant statistical difference in the use of LMWH between IM and EM departments when the Padua score and immobilization criteria were used to assess the risk. The infrequent use of LMWH in EM patients may have several causes. For example, in EM departments, treatment of acute illness often takes higher priority than VTE risk evaluation. Moreover, immobilization criteria cannot be evaluated for all EM patients because of the intrinsic time requirements. For the aforementioned reasons, we believe that a different VTE risk score is required that takes into account the peculiarities of EM, and establishing such a score should be the object of future study.
Collapse
|
5
|
Shlebak A, Sandhu P, Ali V, Jones G, Baker C. The impact of the DoH Commissioning for Quality and Innovation incentive on the success of venous thromboembolism risk assessment in hospitalised patients. A single institution experience in a quality outcome improvement over a 4-year cycle. JRSM Open 2016; 7:2054270416632702. [PMID: 27293773 PMCID: PMC4900198 DOI: 10.1177/2054270416632702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES To i) demonstrate compliance with the Commissioning for Quality and Innovation for venous thromboembolism risk assessment ii) to undertake root cause analysis of Hospital Acquired Thrombosis and to investigate its impact on quality of care. DESIGN Prospective monitoring of all admissions. SETTING Imperial College Healthcare Hospitals, London. PARTICIPANTS All Hospital Provider Spells as defined on the NHS Data Model and Dictionary. MAIN OUTCOME MEASURES i) Percentage of patients undergoing Venous Thromboembolism Risk Assessment (VTE-RA) at and 24-hours after admission ii) root cause analysis of Hospital Acquired Thrombosis up to 90 days following discharge. RESULTS Over a 48-month cycle 83% were overall VTE-RA assessed with 36% in the first 12 months but with significant improvement to ≥95% between April 2013 and April 2015, achieving compliance target since April 2012 involving a massive 633, 850 Spells over the 4 year period. We undertook root cause analysis of all VTE episodes from April 2013 to March 2014, to ascertain Hospital Acquired Thrombosis (HAT), we analysed 433, 174 inpatient days and found a HAT rate of 1 per 1000 with 23% and 24% for DVTs and PEs potentially avoidable respectively. We further analysed VTE risk stratification (n = 1000) and found 37.0% at high risk, 44.4% at medium risk and 18.6 % at low risk, indicating the need of thromboprophylaxis in 81.4% (high and medium) of whom 33.6% were excluded. CONCLUSIONS We achieved 95% RA compliance which has favourably impacted on our daily practice and improved the quality of the clinical care.
Collapse
Affiliation(s)
- Abdul Shlebak
- Department of Haematology, Haemostasis and Thrombosis section
| | | | | | | | - Christopher Baker
- VTE lead, Department of Cardiology, Imperial College Healthcare NHS Trust Hospitals, Praed Street, London, UK, W2 1NY
| |
Collapse
|
6
|
Assareh H, Chen J, Ou L, Hollis SJ, Hillman K, Flabouris A. Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study. BMJ Open 2014; 4:e005502. [PMID: 25280806 PMCID: PMC4187993 DOI: 10.1136/bmjopen-2014-005502] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/25/2014] [Accepted: 08/26/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Despite the burden of venous thromboembolism (VTE) among surgical patients on health systems in Australia, data on VTE incidence and its variation within Australia are lacking. We aim to explore VTE and subsequent mortality rates, trends and variations across Australian acute public hospitals. SETTING A large retrospective cohort study using all elective surgical patients in 82 acute public hospitals during 2002-2009 in New South Wales, Australia. PARTICIPANTS Patients underwent elective surgery within 2 days of admission, aged between 18 and 90 years, and who were not transferred to another acute care facility; 4 362 624 patients were included. OUTCOME MEASURES VTE incidents were identified by secondary diagnostic codes. Poisson mixed models were used to derive adjusted incidence rates and rate ratios (IRR). RESULTS 2/1000 patients developed postoperative VTE. VTE increased by 30% (IRR=1.30, CI 1.19 to 1.42) over the study period. Differences in the VTE rates, trends between hospital peer groups and between hospitals with the highest and those with the lowest rates were significant (between-hospital variation). Smaller hospitals, accommodated in two peer groups, had the lowest overall VTE rates (IRR=0.56:0.33 to 0.95; IRR=0.37:0.23 to 0.61) and exhibited a greater increase (64% and 237% vs 19%) overtime and greater between-hospital variations compared to larger hospitals (IRR=8.64:6.23 to 11.98; IRR=8.92:5.49 to 14.49 vs IRR=3.70:3.32 to 4.12). Mortality among patients with postoperative VTE was 8% and remained stable overtime. No differences in post-VTE death rates and trends were seen between hospital groups; however, larger hospitals exhibited less between-hospital variations (IRR=1.78:1.30 to 2.44) compared to small hospitals (IRR>23). Hospitals performed differently in prevention versus treatment of postoperative VTE. CONCLUSIONS VTE incidence is increasing and there is large variation between-hospital and within-hospital peer groups suggesting a varied compliance with VTE preventative strategies and the potential for targeted interventions and quality improvement opportunities.
Collapse
Affiliation(s)
- Hassan Assareh
- Simpson Centre for Health Services Research, South Western Sydney Clinical School & Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
- Epidemiology, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Jack Chen
- Simpson Centre for Health Services Research, South Western Sydney Clinical School & Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
| | - Lixin Ou
- Simpson Centre for Health Services Research, South Western Sydney Clinical School & Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephanie J Hollis
- Simpson Centre for Health Services Research, South Western Sydney Clinical School & Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
| | - Kenneth Hillman
- Simpson Centre for Health Services Research, South Western Sydney Clinical School & Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
| | - Arthas Flabouris
- Intensive Care Unit, Royal Adelaide Hospital & Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
7
|
Bozzato S, Squizzato A, Donadini MP, Guasti L, Dentali F, Ageno W. Patient selection for thromboprophylaxis in medical inpatients. Expert Rev Cardiovasc Ther 2014; 11:1639-47. [DOI: 10.1586/14779072.2013.845525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
8
|
Eymin G, Jaffer AK. Evidence behind quality of care measures for venous thromboembolism and atrial fibrillation. J Thromb Thrombolysis 2013; 37:87-96. [DOI: 10.1007/s11239-013-0874-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
9
|
Roth-Yelinek B. Venous thromboembolism prophylaxis of acutely ill hospitalized medical patients. Are we under-treating our patients? Eur J Intern Med 2012; 23:236-9. [PMID: 22385880 DOI: 10.1016/j.ejim.2011.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 11/08/2011] [Accepted: 11/08/2011] [Indexed: 11/19/2022]
Abstract
Venous thromboembolism (VTE) is frequent in patients hospitalized in Internal Medicine wards. It carries a considerable morbidity and mortality. Recommendations for use of anticoagulation are graded 1A in leading evidence-based consensus guidelines. Implementation of these guidelines is suboptimal. Lack of awareness seems to be an important factor for the low implementation rate of thromboprophylaxis in Internal Medicine wards, but other factors may be equally important: some clinicians find the data favoring thromboprophylaxis unconvincing or believe that pharmacological prevention is too risky for the average medical inpatient. The following review will show that although there is a dispute about the clinical importance of some manifestations of thromboembolic disease, anticoagulation significantly reduces the risk for clinically relevant VTE. The bleeding risk in most patients is low and does not outweigh the benefit of treatment. Pharmacological or mechanical thromboprophylaxis is cost-effective when administered to at-risk patients. Better awareness and judicious use of risk assessment models should help the attending physician to balance the risk of VTE against the potential bleeding risk.
Collapse
Affiliation(s)
- Batia Roth-Yelinek
- Coagulation unit, Hadassah medical center, Kiryat Hadassah, p.o.b 12000, Jerusalem 91120, Israel.
| |
Collapse
|
10
|
Bhowmik SS, Biswas S, Kharbanda M, Chatterjee TK, Nandy S. Utilization of DVT Prophylaxis in non ICU Hospitalized Patients. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2012. [DOI: 10.1016/s2222-1808(12)60248-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
11
|
Choi WI, Jo JY, Kwon YS, Kim JB, Lee MY. Incidence of pulmonary embolism among hospitalized patients. Thromb Res 2011; 129:523-5. [PMID: 22178580 DOI: 10.1016/j.thromres.2011.11.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 10/30/2011] [Accepted: 11/22/2011] [Indexed: 11/16/2022]
|
12
|
Woller SC, Stevens SM, Jones JP, Lloyd JF, Evans RS, Aston VT, Elliott CG. Derivation and validation of a simple model to identify venous thromboembolism risk in medical patients. Am J Med 2011; 124:947-954.e2. [PMID: 21962315 DOI: 10.1016/j.amjmed.2011.06.004] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 05/26/2011] [Accepted: 06/01/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Fewer than half of eligible hospitalized medical patients receive appropriate venous thromboembolism (VTE) prophylaxis. One reason for this low rate is the complexity of existing risk assessment models. A simple set of easily identifiable risk factors that are highly predictive of VTE among hospitalized medical patients may enhance appropriate thromboprophylaxis. METHODS Electronic medical record interrogation was performed to identify medical admissions from January 1, 2000-December 31, 2007 (n=143,000), and those patients with objectively confirmed VTE during hospitalization or within 90 days following discharge. Putative risk factors most predictive of VTE were identified, and a risk assessment model (RAM) was derived; 46,000 medicine admissions from January 1, 2008-December 31, 2009 served as a validation cohort to test the predictive ability of the RAM. The newly derived RAM was compared with a published VTE assessment tool (Kucher Score). RESULTS Four risk factors: previous VTE; an order for bed rest; peripherally inserted central venous catheterization line; and a cancer diagnosis, were the minimal set most predictive of hospital-associated VTE (area under the receiver operating characteristic curve [AUC]=0.874; 95% confidence interval [CI], 0.869-0.880). These risk factors upon validation in a separate population (validation cohort) retained an AUC=0.843; 95% CI, 0.833-0.852. The ability of the 4-element RAM to identify patients at risk of developing VTE within 90 days was superior to the Kucher Score. CONCLUSIONS The 4-element RAM identified in this study may be used to identify patients at risk for VTE and improve rates of thromboprophylaxis. This simple and accurate RAM is an alternative to more complicated published VTE risk assessment tools that currently exist.
Collapse
|
13
|
Gibbs H, Fletcher J, Blombery P, Collins R, Wheatley D. Venous thromboembolism prophylaxis guideline implementation is improved by nurse directed feedback and audit. Thromb J 2011; 9:7. [PMID: 21466681 PMCID: PMC3080276 DOI: 10.1186/1477-9560-9-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 04/05/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major health and financial burden. VTE impacts health outcomes in surgical and non-surgical patients. VTE prophylaxis is underutilized, particularly amongst high risk medical patients. We conducted a multicentre clinical audit to determine the extent to which appropriate VTE prophylaxis in acutely ill hospitalized medical patients could be improved via implementation of a multifaceted nurse facilitated educational program. METHODS This multicentre clinical audit of 15 Australian hospitals was conducted in 2007-208. The program incorporated a baseline audit to determine the proportion of patients receiving appropriate VTE prophylaxis according to best practice recommendations issued by the Australian and New Zealand Working Party on the Management and Prevention of Venous Thromboembolism (ANZ-WP recommendations), followed by a 4-month education intervention program and a post intervention audit. The primary endpoint was to compare the proportion of patients being appropriately managed based on their risk profile between the two audits. RESULTS A total of 8774 patients (audit 1; 4399 and audit 2; 4375) were included in the study, most (82.2% audit 1; and 81.0% audit 2) were high risk based on ANZ-WP recommendations. At baseline 37.9% of high risk patients were receiving appropriate thromboprophylaxis. This increased to 54.1% in the post intervention audit (absolute improvement 16%; 95% confidence interval [CI] 11.7%, 20.5%). As a result of the nurse educator program, the likelihood of high risk patients being treated according to ANZ-WP recommendations increased significantly (OR 1.96; 1.62, 2.37). CONCLUSION Utilization of VTE prophylaxis amongst hospitalized medical patients can be significantly improved by implementation of a multifaceted educational program coordinated by a dedicated nurse practitioner.
Collapse
Affiliation(s)
- Harry Gibbs
- Director of Cardiology, Lismore Base Hospital, Lismore, NSW, 2480 Australia
| | - John Fletcher
- Department of Surgery, Westmead Hospital, Westmead, NSW, 2145 Australia
| | - Peter Blombery
- Honorary Cardiovascular Physician, Heart Centre, The Alfred Hospital, Melbourne, VIC, 3181 Australia
| | - Renea Collins
- Vascular Medicine Unit, Princess Alexandra Hospital, Brisbane, QLD, 4000 Australia
| | - David Wheatley
- Medical Affairs Clinical Operations, sanofi aventis australia pty ltd, Maquarie Park, NSW, 2113 Australia
| |
Collapse
|