Development and validation of a risk model for hospital-acquired venous thrombosis: the Medical Inpatients Thrombosis and Hemostasis study

医学 红细胞分布宽度 弗雷明翰风险评分 队列 接收机工作特性 肺栓塞 急诊医学 血栓形成 列线图 内科学 风险评估 儿科 计算机安全 计算机科学 疾病
作者
Neil A. Zakai,Katherine Wilkinson,Andrew Sparks,Ryan T. Packer,Insu Koh,Nicholas S. Roetker,Allen B. Repp,Ryan M. Thomas,Chris E. Holmes,Mary Cushman,Timothy B Plante,Hanny Al‐Samkari,Allyson M. Pishko,William A. Wood,Camila Masias,Radhika Gangaraju,Ang Li,David García,Kerri L. Wiggins,Jordan K. Schaefer,Craig Hooper,Nicholas L. Smith,Leslie A. McClure
出处
期刊:Journal of Thrombosis and Haemostasis [Elsevier BV]
卷期号:22 (2): 503-515 被引量:4
标识
DOI:10.1016/j.jtha.2023.10.015
摘要

Background Regulatory organizations recommend assessing hospital-acquired (HA) venous thromboembolism (VTE) risk for medical inpatients. Objectives To develop and validate a risk assessment model (RAM) for HA-VTE in medical inpatients using objective and assessable risk factors knowable at admission. Methods The development cohort included people admitted to medical services at the University of Vermont Medical Center (Burlington, Vermont) between 2010 and 2019, and the validation cohorts included people admitted to Hennepin County Medical Center (Minneapolis, Minnesota), University of Michigan Medical Center (Ann Arbor, Michigan), and Harris Health Systems (Houston, Texas). Individuals with VTE at admission, aged <18 years, and admitted for <1 midnight were excluded. We used a Bayesian penalized regression technique to select candidate HA-VTE risk factors for final inclusion in the RAM. Results The development cohort included 60 633 admissions and 227 HA-VTE, and the validation cohorts included 111 269 admissions and 651 HA-VTE. Seven HA-VTE risk factors with t statistics ≥1.5 were included in the RAM: history of VTE, low hemoglobin level, elevated creatinine level, active cancer, hyponatremia, increased red cell distribution width, and malnutrition. The areas under the receiver operating characteristic curve and calibration slope were 0.72 and 1.10, respectively. The areas under the receiver operating characteristic curve and calibration slope were 0.70 and 0.93 at Hennepin County Medical Center, 0.70 and 0.87 at the University of Michigan Medical Center, and 0.71 and 1.00 at Harris Health Systems, respectively. The RAM performed well stratified by age, sex, and race. Conclusion We developed and validated a RAM for HA-VTE in medical inpatients. By quantifying risk, clinicians can determine the potential benefits of measures to reduce HA-VTE.
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