External validation of a risk assessment model for venous thromboembolism in the hospitalised acutely-ill medical patient (VTE-VALOURR)
External validation of a risk assessment model for venous thromboembolism in the hospitalised acutely-ill medical patient (VTE-VALOURR)
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DOI：
10.1160/th14-03-0239
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发表时间：
2014-10-01
影响因子：
6.7
通讯作者：
Spyropoulos, Alex C.
中科院分区：
文献类型：
--
作者：
Mahan, Charles E.;Liu, Yang;Spyropoulos, Alex C.
静脉血栓栓塞（VTE）的风险评估仍然是一个重要的问题，在住院，急性疾病的医疗患者，和几个静脉血栓栓塞风险评估模型（RAM）已被提出。这项大型回顾性队列研究的目的是使用三家急性护理医院的大型数据库对IMPROVE RAM进行外部验证。我们研究了VIE队列中41，486例住院（28，744例独特患者），其中1，240例VTE住院（1，135例独特患者），对照队列中40，246例无VIE住院（27，609例独特患者）。在病历审查后，确定了139名独特的VIE患者，并在对照队列中随机选择了278名匹配患者。作为衍生队列中RAM的一部分，确定了7个独立的VIE风险因素。在验证队列中，VIE的发生率为0.20%; 95%置信区间（CI）为0.18 - 0.22，1.04%; 95%CI为0.88 - 1.25，4.15%;低、中和高VIE风险组的95%CI分别为2.79 - 8.12，而衍生队列的三个风险类别的发生率分别为0.45%、1.3%和4.74%。对于推导和验证队列，低、中和高VIE风险患者的总百分比分别为68.6% vs 63.3%、24.8% vs 31.1%和6.5% vs 5.5%。总体而言，验证队列的受试者-操作者特征曲线下面积为0.7731。总之，IMPROVE RAM可以准确识别低、中、高VIE风险的医疗患者。这将调整未来的血栓预防策略，在这一人群中，以及确定特别高的VIE风险的患者，其中多模式或更密集的预防可能是有益的。
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 VIE cohort and 40,246 VIE-free hospitalisations (27,609 unique patients) in the control cohort. After chart review, 139 unique VIE patients were identified and 278 randomly-selected matched patients in the control cohort. Seven independent VIE risk factors as part of the RAM in the derivation cohort were identified. In the validation cohort, the incidence of VIE 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 VIE 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 VIE 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 VIE risk. This will tailor future thromboprophylactic strategies in this ' population as well as identify particularly high VIE risk patients in whom multimodal or more intensive prophylaxis may be beneficial.