scholarly journals Risk Assessing Medical Inpatients for Hospital-Acquired Venous Thrombosis: The Medical Inpatients Thrombosis and Hemostasis (MITH) Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 829-829
Author(s):  
Neil A. Zakai ◽  
Insu Koh ◽  
Katherine Wilkinson ◽  
Nicholas S Roetker ◽  
Andrew D Sparks ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Predictive Value ◽  
Chart Review ◽  
Distribution Width ◽  
Final Model ◽  
Objective Risk ◽  
Medical Inpatients ◽  
Hospital Acquired ◽  
Active Cancer

Abstract Introduction: Multiple regulatory agencies and professional societies recommend risk assessment of hospitalized medical patients for hospital-acquired (HA) venous thromboembolism (VTE) and provision of pharmacologic prophylaxis to those at risk. Extant risk assessment models (RAMs) include risk factors not knowable or difficult to assess at admission and often do not include risk factors reflecting illness acuity (such as laboratory studies and vital signs at admission). We developed a RAM for HA-VTE that reports absolute VTE risk, as opposed to arbitrary risk categories, using only objective risk factors measured within the first 24 hours of admission. Methods: The study setting was a combined academic and community 540-bed teaching hospital in northwest Vermont (The University of Vermont Medical Center). Using validated electronic health record (EHR) derived phenotypes (computable phenotypes), we captured all medical admissions between 2010-2019 and examined patient demographics, past medical history, and presenting vital and laboratory measures as potential risk factors for HA-VTE. As risk assessment should happen within 24 hours of admission, we only assessed risk factors knowable within this timeframe. Individuals with VTE at admission were excluded. Key outcome and risk factor definitions were validated using chart review. Bayesian logistic regression with a least absolute shrinkage and selection operator (LASSO) prior probability distribution was used to select risk factors for the model. Variables with a t-statistic ≥1.5 or ≤-1.5 were included in the final model. Full or prophylactic anticoagulation use was adjusted for in the final model. Model performance was assessed using bootstrap resampling to estimate area under the receiver operating characteristic (AUC) curve and calibration slope with 95% confidence interval (CI). Results: There were 62,468 medical admissions in the study period with 219 HA-VTE events. Chart review demonstrated the positive predictive value of our HA-VTE computable phenotype to be 84% and the negative predictive value 99%. Mean age was 65 years and 51% were male. Comorbid conditions were common in this hospitalized population, including active cancer (29%), congestive heart failure (25%), diabetes (27%), hypertension (59%), and prior myocardial infarction (13%). Seven risk factors met the criteria for inclusion in the final model: prior history of VTE (OR 2.7; 95% CI 1.8, 3.8), red cell distribution width ≥14.7% (OR 1.6; 95% CI 1.2, 2.2), creatinine ≥2.0 mg/dL or on dialysis (OR 2.0; 95% CI 1.4, 2.8), serum sodium <136 MEq/L (OR 1.5; 95% CI 1.1, 2.1), active cancer (OR 1.4; 95% CI 1.1, 2.0), malnutrition based on prior reported weight loss (OR 2.1; 95% CI 1.3, 3.3), and low hemoglobin (<13.6 g/dL in men, <12.1 g/dL in women; OR 1.5; 95% CI 1.0, 2.1). The unadjusted AUC of the RAM was 0.73 with an unadjusted calibration slope 1.09 (Figure 1). The optimism-adjusted AUC was 0.68 (95% CI 0.64, 0.71) and the optimism-adjusted calibration slope was 0.87 (95% CI: 0.72, 1.03). Discussion: We developed and internally validated a RAM for HA-VTE during medical hospitalization which incorporates simple, objective risk factors knowable within the first 24 hours of admission. Unlike most prior RAMs, this model also incorporates risk factors reflecting illness severity such as laboratory results. The RAM has good fit and calibration and will be moved forward to external validation. Future applications include incorporating the RAM into hospital admission workflows and assessing VTE prophylaxis rates and the incidence of HA-VTE and HA-bleeding. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Clostridium Difficile As a Risk Factor For Hospital-Acquired Venous Thrombosis In Medical Inpatients

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1682-1682
Author(s):  
Samuel A Merrill ◽  
Michael Desarno ◽  
Damon Houghton ◽  
John P. Winters ◽  
Christopher Huston ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Risk Factor ◽  
Venous Thrombosis ◽  
Chart Review ◽  
Validation Cohort ◽  
Conflicts Of Interest ◽  
Derivation Cohort ◽  
Medical Inpatients ◽  
Hospital Acquired

Abstract Introduction The American College of Chest Physicians and government agencies recommend risk stratification and pharmacologic prophylaxis to prevent venous thromboembolism (VT) in hospitalized individuals. While risk factor assessment is often completed at admission, clinical changes during hospitalization may influence VT risk. Based on clinical observation of coincidence of C. difficile infection and VT, we sought to determine if C. diff or clinical suspicion of C. diff are risk factors for hospital acquired VT in medical inpatients. Methods Derivation and validation cohorts for the Medical Inpatient Venous Thrombosis Risk Assessment Score were used. Patients were admitted to the medical services at Fletcher Allen Health Care, a 500 bed teaching hospital for the University of Vermont. For derivation, all cases of hospital-acquired VT between 2002-2009 were identified using ICD-9 codes and verified by chart review; cases were matched by admission year and medical service to controls; VT risk factors and C. diff testing and Results were confirmed by chart review. For validation, hospital-acquired VT between 2009-2012 were captured by ICD-9 codes with confirmatory imaging; testing and Results for C. diff were ascertained from the microbiology lab database; VT risk factors were ascertained by ICD-9 codes, electronic problem lists, vital sign data, and lab values. Logistic regression, accounting for VT risk factors (Table), was used to determine whether 1) testing for C. diff or 2) a positive confirmation for C. diff was associated with hospital-acquired VT. Results In the derivation analysis 299 cases of hospital-acquired VT were identified from 64,334 medical admissions and matched to 601 controls. In the validation analysis 120 hospital-acquired VT were identified among 20,946 admissions. In the derivation cohort there were 4,793 tests for C. diff and 478 confirmed cases; and in the validation cohort there were 1,708 tests for C. diff and 260 confirmed cases. After accounting for other VT risk factors in the derivation cohort, testing for C. diff was associated with an OR of 2.14 (95% CI 1.28, 3.61) for VT, positive C. diff with an OR of 3.23 (95% CI 1.00, 10.45) for VT, and negative C. diff with an OR of 1.95 (95% CI 1.09-3.46) for VT. These associations were confirmed in the validation cohort (see Table). Conclusions Both testing for, and a diagnosis of C. diff were associated with hospital-acquired VT in medical inpatients. This relationship could be a surrogate of antimicrobial therapy indicating another active infection or a general marker for systemic illness, direct causation appears less likely. These data suggest that VT risk is dynamic during hospitalization and that further studies incorporating dynamic VT risk assessment are warranted in medical inpatients. Disclosures: No relevant conflicts of interest to declare.

Validation Of Medical Inpatient Venous Thrombosis Risk Assessment (MITH) Score

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2931-2931
Author(s):  
Damon E Houghton ◽  
Michael Desarno ◽  
Peter Callas ◽  
Allen B Repp ◽  
Mary Cushman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Risk Factor ◽  
Venous Thrombosis ◽  
Sensitivity And Specificity ◽  
Validation Cohort ◽  
Medical Inpatients ◽  
History Of ◽  
Hospital Acquired ◽  
Present On Admission

Abstract Introduction Governmental agencies recommend risk assessment of venous thrombosis (VT) for medical inpatients at admission and provision of VT prophylaxis for moderate to high risk patients. While several risk factor models for predicting hospital-acquired VT have been proposed, none have been widely accepted and few have been prospectively validated. We sought to validate the recently published MITH VT risk assessment model in an independent cohort of medical inpatients (Zakai et al, Journal of Thrombosis and Haemostasis 2013). Methods Hospital-acquired VT and risk factors present at admission were collected from adult inpatients between June 2009 and April 2012 admitted to the medicine, medical intensive care, hematology/oncology, or cardiology services at Fletcher Allen Hospital (500 bed teaching hospital for the University of Vermont). Hospital-acquired VT was defined using VT discharge ICD-9 codes (flagged as not present on admission) and record of an imaging study that could diagnosis VT (such as duplex ultrasound, computed tomography angiography, or ventilation perfusions scan). Inpatients with VT ICD-9 codes flagged as present on admission were excluded. The sensitivity and specificity of the definition was confirmed by chart review of 30 cases of hospital-acquired VTE and 30 non-cases. Risk factors for hospital-acquired VT were captured using ICD-9 codes from the problem list, discharge codes, vital signs, and laboratory values at admission. The MITH score was calculated for each patient based on the points for each risk factor: history of heart failure = 5 pts, history of rheumatologic disease = 4 pts, history of fracture in past 3 months = 3 pts, history of cancer in past 12 months = 1 pt, tachycardia (HR>100 at admission) = 2pt, respiratory dysfunction (SpO2<90% at admission or intubated on hospital day 1) = 1 pt, white blood cell count >11 = 1 pt, platelet count >350 = 1 pt. The absolute rates of hospital-acquired VT for different cut points of the score were calculated and compared qualitatively to those previously published for the MITH score. Results There were 120 hospital-acquired VT events complicating 20,334 medical admissions (5.9 cases per 1,000 hospital admissions). The sensitivity and specificity of our definition of hospital-acquired VT was 100% and 91%, respectively. The table presents the prevalence of the MITH score at various cut-offs in cases and non-cases as well as the incidence of VT. In the derivation of the MITH score, the rate of VT per 1000 admissions for a score <1, <2, or <3 was 1.0, 1.5, and 2.1 compared with 0.7, 1.8, and 2.2 VT per 1000 admissions for the validation cohort. The incidence of VTE in the derivation of the MITH score for a score ≥1, ≥2, and ≥3 was 6.0, 8.9, and 12.4 per 1000 admissions compared with 7.9, 9.0, and 10.3 per 1000 admissions in the validation cohort. Conclusions We have validated a previously published VT risk score for hospitalized medical patients in an independent population. Determination of a patient's risk of VT at admission using readily available clinical and laboratory data could allow physicians to make informed decisions about risks and benefits of DVT prophylaxis. Further work is required to determine at what level of risk pharmacologic VT prophylaxis is warranted in this patient population. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Polish Translation and Validation of the Mini Sarcopenia Risk Assessment (MSRA) Questionnaire to Assess Nutritional and Non-Nutritional Risk Factors of Sarcopenia in Older Adults

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1061
Author(s):  
Roma Krzymińska-Siemaszko ◽  
Ewa Deskur-Śmielecka ◽  
Arkadiusz Styszyński ◽  
Katarzyna Wieczorowska-Tobis
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Assessment ◽  
Predictive Value ◽  
High Sensitivity ◽  
Community Dwelling ◽  
Nutritional Risk ◽  
Polish Language ◽  
Community Dwelling Older Adults ◽  
Translation And Validation

A simple, short, cheap, and reasonably sensitive and specific screening tool assessing both nutritional and non-nutritional risk factors for sarcopenia is needed. Potentially, such a tool may be the Mini Sarcopenia Risk Assessment (MSRA) Questionnaire, which is available in a seven-item (MSRA-7) and five-item (MSRA-5) version. The study’s aim was Polish translation and validation of both MSRA versions in 160 volunteers aged ≥60 years. MSRA was validated against the six sets of international diagnostic criteria for sarcopenia used as the reference standards. PL-MSRA-7 and PL-MSRA-5 both had high sensitivity (≥84.9%), regardless of the reference standard. The PL-MSRA-5 had better specificity (44.7–47.2%) than the PL-MSRA-7 (33.1–34.7%). Both questionnaires had similarly low positive predictive value (PL-MSRA-5: 17.9–29.5%; PL-MSRA-7: 14.4–25.2%). The negative predictive value was generally high for both questionnaires (PL-MSRA-7: 89.8–95.9%; PL-MSRA-5: 92.3–98.5%). PL-MSRA-5 had higher accuracy than the PL-MSRA-7 (50.0–55% vs. 39.4–45%, respectively). Based on the results, the Mini Sarcopenia Risk Assessment questionnaire was successfully adopted to the Polish language and validated in community-dwelling older adults from Poland. When compared with PL-MSRA-7, PL-MSRA-5 is a better tool for sarcopenia risk assessment.

scholarly journals Risk-assessment models for VTE and bleeding in hospitalized medical patients: an overview of systematic reviews

2020 ◽  
Vol 4 (19) ◽  
pp. 4929-4944
Author(s):  
Andrea J. Darzi ◽  
Allen B. Repp ◽  
Frederick A. Spencer ◽  
Rami Z. Morsi ◽  
Rana Charide ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Systematic Reviews ◽  
Risk Of Bias ◽  
Clinical Expertise ◽  
Medical Patients ◽  
Vte Prophylaxis ◽  
Risk Assessment Models ◽  
Medical Inpatients ◽  
Overview Of Systematic Reviews

Abstract Multiple risk-assessment models (RAMs) for venous thromboembolism (VTE) in hospitalized medical patients have been developed. To inform the 2018 American Society of Hematology (ASH) guidelines on VTE, we conducted an overview of systematic reviews to identify and summarize evidence related to RAMs for VTE and bleeding in medical inpatients. We searched Epistemonikos, the Cochrane Database, Medline, and Embase from 2005 through June 2017 and then updated the search in January 2020 to identify systematic reviews that included RAMs for VTE and bleeding in medical inpatients. We conducted study selection, data abstraction and quality assessment (using the Risk of Bias in Systematic Reviews [ROBIS] tool) independently and in duplicate. We described the characteristics of the reviews and their included studies, and compared the identified RAMs using narrative synthesis. Of 15 348 citations, we included 2 systematic reviews, of which 1 had low risk of bias. The reviews included 19 unique studies reporting on 15 RAMs. Seven of the RAMs were derived using individual patient data in which risk factors were included based on their predictive ability in a regression analysis. The other 8 RAMs were empirically developed using consensus approaches, risk factors identified from a literature review, and clinical expertise. The RAMs that have been externally validated include the Caprini, Geneva, IMPROVE, Kucher, and Padua RAMs. The Padua, Geneva, and Kucher RAMs have been evaluated in impact studies that reported an increase in appropriate VTE prophylaxis rates. Our findings informed the ASH guidelines. They also aim to guide health care practitioners in their decision-making processes regarding appropriate individual prophylactic management.

Venous thromboembolic risk and thromboprophylaxis in acutely ill medical outpatients

Phlebologie ◽  
2006 ◽  
Vol 35 (06) ◽  
pp. 286-288
Author(s):  
V. Hach-Wunderle ◽  
F. H. Mader ◽  
W. D. Paar ◽  
S. K. Haas
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Family Physicians ◽  
Medical Illness ◽  
Thromboembolic Risk ◽  
Objective Risk ◽  
Subjective Risk ◽  
Venous Thromboembolic ◽  
Objective Score ◽  
Medical Outpatients

Summary215 German family physicians participated in a prospective registry to assess the venous thromboembolic risk in acutely ill medical outpatients. In 1247 patients who were visited at home due to an acute medical illness, the risk factors were documented using a standardised questionnaire. The doctors subjectively rated the patient’s risk on a scale ranging from 1 to 10 and the result was compared with an objective risk-score which had been previously developed for hospitalized patients and has been successfully used in these patients. The results showed a wide agreement of the subjective risk assessment and the objective score. The resulting consequence of an adequate thromboprophylaxis reflects a high awareness of venous thromboembolic risk among the physicians treating acutely ill medical outpatients.

scholarly journals Association of Platelet Parameters in Acute Coronary Syndrome before and after Anti-platelet Therapy

2018 ◽  
Vol 43 (2) ◽  
pp. 52-57
Author(s):  
Silpi Pervin ◽  
Mosharaf Hossain ◽  
Tuhin Sultana ◽  
Debatosh Paul ◽  
Choudhury Meshkat Ahmed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Distribution Width ◽  
Blood Samples ◽  
Platelet Counts ◽  
Coronary Syndrome ◽  
Anti Platelet Therapy ◽  
Sensitivity Specificity

Identification of risk factors for acute coronary syndrome (ACS) is important for both diagnostic and prognostic purposes. Among the platelet parameters- mean platelet volume (MPV) and platelet distribution width (PDW) are thought to be risk factors of ACS. This quasi- experimental study was conducted from September 2011 to August 2012 in the Department of Clinical Pathology, in collaboration with Departments of Cardiology, Bangbandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) . It was enrolled 79 patients with ACS, diagnosed based on clinical history, electrocardiographic changes and increased cardiac markers especially troponin I, and 63 subjects were enrolled as control. For determination of platelet parameters, the blood samples were obtained from all patients of ACS before anti-platelet therapy when patient attended in the cardiac emergency and after 5th day of ongoing anti-platelet therapy; and from control group on the 1st day and 5th day at outpatient department. The blood samples were taken properly and processed in haematology autoanalyser. In this study, the baseline characteristics of study patients were measured. Platelet counts were 273.1±50.15 x 109/L in patients with ACS and 290.78±74.86 x 109/L in control subjects in 1st sample and 284.56±41.93 x 109/L in patients with ACS in 2nd sample. In 1st samples, platelet counts were slightly low in patients with ACS compared to controls and 2nd samples. There were no statistical significant differences between the groups and the samples. MPV was 12.48±1.17 fl and 10.45±0.66 fl in patients with ACS and controls and 11.55±1.08 fl in 2nd sample in ACS cases. PDW was 16.23±2.56 fl, 11.89±1.42 fl and 14.29±2.11 fl in patients with ACS, controls and 2nd sample of ACS cases respectively. Both MPV and PDW were statistically significant between the groups and the samples (p<0.001). The sensitivity, specificity, positive and negative predictive value of platelet parameters of ACS cases were obtained from ROC curve and compared with controls. The best cut off value of platelet count, MPV and PDW were >225 x 109/L, > 10.7 fl and >12.7 fl respectively. The sensitivity, specificity, accuracy, positive and negative predictive value of platelet counts, MPV and PDW were 83%, 28.1%, 42.3%, 37.6%, 64%; 90.6%, 49.4%, 64.8%, 51.6%, 89.8%; and 94.3%,52.8%, 69%,54.9%, 94.1% respectively. The study showed that PDW had higher sensitivity and specificity in contrast to MPV. Platelet parameters were increased in patients with ACS before anti-platelet therapy and gradually decreased after anti-platelet therapy. These two markers may used as predictor for early detection of ACS and risk stratification, when other cardiac biomarkers are negative.

scholarly journals Risk factors for the development of hospital-acquired pediatric venous thromboembolism—Dealing with potentially causal and confounding risk factors using a directed acyclic graph (DAG) analysis

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242311
Author(s):  
Leonardo Rodrigues Campos ◽  
Maurício Petroli ◽  
Flavio Roberto Sztajnbok ◽  
Elaine Sobral da Costa ◽  
Leonardo Rodrigues Brandão ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nephrotic Syndrome ◽  
Directed Acyclic Graph ◽  
Case Control Study ◽  
Case Control ◽  
Final Model ◽  
Acyclic Graph ◽  
Potential Risk Factors ◽  
Hospital Acquired ◽  
Control Study

Introduction Hospital-acquired venous thromboembolism (HA-VTE) in children comprises multiple risk factors that should not be evaluated separately due to collinearity and multiple cause and effect relationships. This is one of the first case-control study of pediatric HA-VTE risk factors using a Directed Acyclic Graph (DAG) analysis. Material and methods Retrospective, case-control study with 22 cases of objectively confirmed HA-VTE and 76 controls matched by age, sex, unit of admission, and period of hospitalization. Descriptive statistics were used to define distributions of continuous variables, frequencies, and proportions of categorical variables, comparing cases and controls. Due to many potential risk factors of HA-VTE, a directed acyclic graph (DAG) model was created to identify confounding, reduce bias, and increase precision on the analysis. The final model consisted of a DAG-informed conditional logistic regression. Results In the initial conventional univariable model, the following variables were selected as potential risk factors for HA-VTE: length of stay (LOS, days), immobility, ICU admission in the last 30 days, LOS in ICU, infection, central venous catheter (CVC), number of CVCs placed, L-asparaginase, heart failure, liver failure, and nephrotic syndrome. The final model using the set of variables selected by DAG analysis revealed LOS (OR = 1.106, 95%CI = 1.021–1.198, p = 0.013), L-asparaginase (OR = 26.463, 95%CI = 1.609–435.342, p = 0.022), and nephrotic syndrome (OR = 29.127, 95%CI = 1.044–812.508, p = 0.004) as independent risk factors for HA-VTE. Conclusion The DAG-based approach was useful to clarify the influence of confounders and multiple causalities of HA-VTE. Interestingly, CVC placement—a known thrombotic risk factor highlighted in several studies—was considered a confounder, while LOS, L-asparaginase use and nephrotic syndrome were confirmed as risk factors to HA-VTE. Large confidence intervals are related to the sample size; however, the results were significant.

Abstract P193: Infection Type and Severity are Risk Factors for Hospital-Acquired Venous Thromboembolism in Medical Inpatients

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Samuel Merrill ◽  
Michael Desarno ◽  
Damon Houghton ◽  
Christopher Huston ◽  
Peter Callas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Infection Type ◽  
Organ System ◽  
Related Risk ◽  
Medical Inpatients ◽  
Risk Patients ◽  
Culture Isolate ◽  
Hospital Acquired ◽  
The Relationship

Introduction: Hospital-acquired venous thromboembolism (HAVTE) leads to increased length of stay, cost, morbidity, and is a target of government quality measures. How infection relates to HAVTE risk is unknown. We wished to identify infection-related risk factors for HAVTE to help identify at-risk patients and to guide prevention efforts. Hypothesis: We hypothesized that increased infection severity, affected organ system, and positive microbiology culture results were associated with HAVTE in medical inpatients. Methods: HAVTE between 2009-2012 were identified by ICD-9 codes with confirmatory imaging at a 500 bed teaching hospital. ICD-9 codes, microbiology results, lab and vital sign data, and medication records were used to classify infections as presented in the Table. Logistic regression was used to determine odds ratios (OR) and 95% confidence intervals (CI) for HAVTE adjusting for known HAVTE risk factors in the MITH score, a previously developed HAVTE risk score for medical inpatients. Models incorporated known HAVTE risk factors and assessed each variable from the Table individually. Results: In 20,327 medical admissions there were 113 hospital-acquired HAVTE (incidence: 0.56%). The table presents the association between infection-related risk factors and HAVTE. Septic shock (OR 7.48), sepsis (OR 5.9), and MSSA culture isolate (OR 6.39) had the greatest point-estimates of HAVTE after adjusting for known HAVTE risk factors. Conclusions: Infection severity, affected organ system, and microbiologic etiology were risk factors for HAVTE after adjusting for known risk factors. The relationship between these risk factors and thrombosis is likely complex, but these risk factors are easily measureable using the electronic health record. These results may help facilitate HAVTE prevention by further identifying high risk patients.

Abstract P253: Impact of Hospital-Acquired Venous Thrombosis on Mortality in Medical Inpatients: The Medical Inpatients and Thrombosis (MITH) Study.

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Catherine R Mygatt ◽  
Peter W Callas ◽  
Mary Cushman ◽  
Allen B Repp ◽  
Neil A Zakai
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Venous Thrombosis ◽  
Medical Record ◽  
Odds Ratio ◽  
Medical Patients ◽  
Risk Of Death ◽  
Medical Inpatients ◽  
Record Review ◽  
Hospital Acquired

Introduction: The Joint Commission mandates assessing risk and providing venous thrombosis (VT) prophylaxis in hospital inpatients. Pharmacologic VT prophylaxis reduces VT among medical inpatients, but the impact on survival is unknown. We studied the association of hospital acquired VT and VT prophylaxis with risk of inpatient mortality. Methods: We identified all cases of VT complicating medical admissions at a 500 bed teaching hospital in Burlington, Vermont from January 2002 to June 2009. VT cases were identified using ICD-9 codes, confirmed by medical record review, and frequency matched 1:2 to patients without VT by admission year and service (oncology, general medicine or cardiology). Death from VT was determined by medical record review and standardized criteria. We calculated odds ratios (OR) of death for hospital-acquired VT and VT prophylaxis using weighted multivariable logistic regression and 95% confidence intervals (CI) using the Taylor series method. Results: Of 64,334 admissions, 299 patients had hospital-acquired VT. 56 of these died from any cause and 24 died due to their VT. For every 1000 admissions, 87 ended in death and 4.6 had a hospital-acquired VT. Hospital-acquired VT was associated with increased odds of death, but this was attenuated by adjustment for other risk factors for death ( Table ). VT prophylaxis was inversely associated with odds of death when similarly adjusted ( Table ). Conclusions: One in 235 deaths in medical patients was attributable to hospital-acquired VT, a potentially preventable event. Occurrence of VT after admission in medical patients was associated with risk of death, but this was mediated by other patient characteristics. Findings suggest providing VT prophylaxis reduces risk of death in hospital, but this requires confirmation due to the low number of deaths in this study. Table Multivariable Model of Risk Factors for In-Hospital Mortality Risk Factor Unadjusted Odds Ratio (95% CI) Adjusted Odds Ratio (95% CI) * VT occurring during admission 2.41 (1.54, 3.77) 1.21 (0.58, 2.53) VT prophylaxis provided throughout admission ** 1.15 (0.51, 2.62) 0.48 (0.16, 1.45) * Model adjusted for the following (measured on admission unless indicated): sex, age, systolic blood pressure, diastolic blood pressure, heart rate, hypoxic or ventilated, pneumonia, metastatic cancer, history of myocardial infarction, dementia, use of full anticoagulation, VT prophylaxis stopped during admission, admitted or transferred to intensive care. ** Reference group: no prophylaxis or anticoagulation during admission.

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