Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada
Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada
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DOI：
10.1016/j.thromres.2006.01.011
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发表时间：
2007-01-01
影响因子：
7.5
通讯作者：
Sebaldt, Rolf J.
中科院分区：
文献类型：
--
作者：
Kahn, Susan R.;Panju, Akbar;Sebaldt, Rolf J.
背景：已证明对急症患者进行静脉血栓栓塞（VTE）预防是安全有效的。这种患者安全实践的不充分可能会导致可避免的死亡率和发病率。 目标：我们的目的是确定加拿大各地有资格接受血栓预防的住院急症内科患者的比例，并评估其使用频率、决定因素和适当性。患者/方法：CURVE 是对 29 家加拿大医院进行的全国性多中心图表审计。在规定的三周研究期内，收集了因急性疾病入院的连续患者的数据。记录人口统计学和临床特征、VTE 和出血的危险因素以及 VTE 预防的使用信息。使用基于国际共识指南的预先指定标准评估 VTE 预防的适应症和适当性。进行多变量分析以确定预防使用的决定因素。结果：在研究期间筛选的 4124 名入院患者中，1894 名患者 (46%) 符合研究纳入资格。最常见的入院诊断是严重感染（28%）、慢性阻塞性肺疾病（COPID）恶化或呼吸衰竭（12%）、恶性肿瘤（9%）和充血性心力衰竭（13%）。 1702 名（90%）研究患者需要进行血栓预防。总体而言，23% 的患者接受了某种形式的预防。然而，只有 16% 接受了适当的血栓预防治疗。与更多使用预防药独立相关的因素包括内科医生（相对于其他专业）作为主治医生（OR 1.33，95％置信区间（CI）[1.03，1.71]），大学附属（相对于社区）医院（OR 1.46，95％CI [1.03，2.07]），固定（每天）（OR 1.60，95％CI） [1.45, 1.77]）、存在 >= 1 个 VTE 危险因素（OR = 1.78, 95% CI [1.35, 2.34]）和住院时间（每天住院）（OR 1.05, 95% CI [1.03, 1.071），然而，所有组中预防治疗的使用率低得令人无法接受。癌症患者接受预防治疗的可能性显着降低（OR = 0.40，95% CI [0.24，0.68]）。出血危险因素的存在并不影响预防治疗的使用或选择。结论：大多数因内科疾病住院的患者都有血栓预防的指征，但只有 16% 的患者接受了适当的预防治疗。应努力阐明内科患者血栓预防率极低的原因，并制定和测试策略以改善患者安全实践的实施。 0 2006 Elsevier Ltd. 保留所有权利。
Background: Venous thromboembotism (VTE) prophylaxis in acutely ill medical patients has been shown to be safe and effective. Underutitization of this patient safety practice may result in avoidable mortality and morbidity.Objectives: We aimed to determine the proportion of hospitalized, acutely ill medical patients across Canada who were eligible to receive thromboprophylaxis and to evaluate the frequency, determinants and appropriateness of its use.Patients/methods: CURVE is a national, multicenter chart audit of 29 Canadian hospitals. Data were collected on consecutive patients admitted to hospital for an acute medical illness during a defined 3-week study period. Information on demographic and clinical characteristics, risk factors for VTE and bleeding and use of VTE prophylaxis were recorded. The indications for and appropriateness of VTE prophylaxis were assessed using pre-specified criteria based on international consensus guidelines. Multivariable analyses were performed to identify determinants of prophylaxis use.Results: Of the 4124 medical admissions screened over the study period, 1894 patients (46%) were eligible for study inclusion. The most common specified admitting diagnoses were severe infection (28%), COPID exacerbation or respiratory failure (12%), malignancy (9%) and congestive heart failure (13%). Thromboprophylaxis was indicated in 1702 (90%) study patients. Overall, some form of prophylaxis was administered to 23% of all patients. However, only 16% received appropriate thromboprophytaxis. Factors independently associated with greater use of prophytaxis included internist (vs. other specialty) as attending physician (OR 1.33, 95% confidence interval (CI) [1.03, 1.71]), university-associated (vs. community) hospital (OR 1.46, 95% CI [1.03, 2.07]), immobilization (per day) (OR 1.60, 95% CI [1.45, 1.77]), presence of >= 1 VTE risk factors (OR = 1.78, 95% CI [1.35, 2.34]) and duration of hospitalization (per day of stay) (OR 1.05, 95% CI [1.03, 1.071), however, use of prophylaxis was unacceptably tow in all groups. Patients with cancer had a significantly reduced likelihood of receiving prophylaxis (OR = 0.40, 95% CI [0.24, 0.68]). Presence of risk factors for bleeding did not influence the use or choice of prophylaxis.Conclusion: Most patients hospitalized for medical illness had indications for thromboprophytaxis, yet only 16% received appropriate prophytaxis. Efforts should be made to elucidate the reasons that underlie the very low rate of thromboprophylaxis in medical patients and to develop and test strategies to improve implementation of this patient safety practice. 0 2006 Elsevier Ltd. All rights reserved.