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External validation of a risk assessment model for venous thromboembolism in the hospitalised acutely-ill medical patient (VTE-VALOURR)

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
Topic:

Theme Issue
Infections and the role of plasma proteins and platelets

DOI: https://doi.org/10.1160/TH14-03-0239
Issue: 2014: 112/4 (Oct) pp. 627-842
Pages: 692-699
Ahead of Print: 2014-07-03

External validation of a risk assessment model for venous thromboembolism in the hospitalised acutely-ill medical patient (VTE-VALOURR)

Online Supplementary Material

See also Editorial by Squizzato, Ageno

C. E. Mahan (1), Y. Liu (2), A. G. Turpie (3), J. T. Vu (4), N. Heddle (2), R. J. Cook (5), U. Dairkee (3), A. C. Spyropoulos (6)

(1) Presbyterian Healthcare Services, University of New Mexico, Albuquerque, New Mexico, USA; (2) McMaster Transfusion Research Program, McMaster University, Hamilton, Ontario, Canada; (3) Department of Medicine, McMaster University, Hamilton, Ontario, Canada; (4) Texas Children’s Hospital, Houston, Texas, USA; (5) Professor of Statistical Methods for Health Research, University of Waterloo, Waterloo, Ontario, Canada; (6) Anticoagulation Services and Clinical Thrombosis, North Shore-LIJ Health System at Lenox Hill Hospital, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, USA

Keywords

Validation, prevention, hospitalised medical patients, Venous thromboembolism risk assessment, risk assessment models

Summary

Venous thromboembolic (VTE) risk assessment remains an important issue in hospitalised, acutely-ill medical patients, and several VTE risk assessment models (RAM) have been proposed. The purpose of this large retrospective cohort study was to externally validate the IMPROVE RAM using a large database of three acute care hospitals. We studied 41,486 hospitalisations (28,744 unique patients) with 1,240 VTE hospitalisations (1,135 unique patients) in the VTE cohort and 40,246 VTE-free hospitalisations (27,609 unique patients) in the control cohort. After chart review, 139 unique VTE patients were identified and 278 randomly-selected matched patients in the control cohort. Seven independent VTE risk factors as part of the RAM in the derivation cohort were identified. In the validation cohort, the incidence of VTE was 0.20%; 95% confidence interval (CI) 0.18–0.22, 1.04%; 95%CI 0.88–1.25, and 4.15%; 95%CI 2.79–8.12 in the low, moderate, and high VTE risk groups, respectively, which compared to rates of 0.45%, 1.3%, and 4.74% in the three risk categories of the derivation cohort. For the derivation and validation cohorts, the total percentage of patients in low, moderate and high VTE risk occurred in 68.6% vs 63.3%, 24.8% vs 31.1%, and 6.5% vs 5.5%, respectively. Overall, the area under the receiver-operator characteristics curve for the validation cohort was 0.7731. In conclusion, the IMPROVE RAM can accurately identify medical patients at low, moderate, and high VTE risk. This will tailor future thromboprophylactic strategies in this population as well as identify particularly high VTE risk patients in whom multimodal or more intensive prophylaxis may be beneficial.

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