医学
逻辑回归
静脉血栓栓塞
风险评估
危险分层
内科学
静脉血栓形成
医疗保健
急诊医学
血栓形成
计算机安全
计算机科学
经济
经济增长
作者
Erik H. Hoyer,Aditya Bhave,Wingel Xue,Elliott R. Haut,Brandyn Lau,Peggy S. Kraus,Alison E. Turnbull,Dauryne L. Shaffer,Lisa Aronson Friedman,Daniel L. Young,Daniel J. Brotman,Michael B. Streiff
标识
DOI:10.1016/j.amjmed.2024.04.003
摘要
Abstract
Background
Venous thromboembolism risk increases in hospitals due to reduced patient mobility. However, initial mobility evaluations for thromboembolism risk are often subjective and lack standardization, potentially leading to inaccurate risk assessments and insufficient prevention. Methods
A retrospective study at a quaternary academic hospital analyzed patients using the Padua risk tool, which includes a mobility question, and the Johns Hopkins-Highest Level of Mobility (JH-HLM) scores to objectively measure mobility. Reduced mobility was defined as JH-HLM scores ≤3 over ≥3 consecutive days. The study evaluated the association between reduced mobility and hospital-acquired venous thromboembolism using multivariable logistic regression, comparing admitting health care professional assessments with JH-HLM scores. Symptomatic, hospital-acquired thromboembolisms were diagnosed radiographically by treating providers. Results
Of 1715 patients, 33 (1.9%) developed venous thromboembolisms. Reduced mobility, as determined by the JH-HLM scores, showed a significant association with thromboembolic events (adjusted OR: 2.53, 95%CI:1.23-5.22, P=0.012). In contrast, the initial Padua assessment of expected reduced mobility at admission did not. The JH-HLM identified 19.1% of patients as having reduced mobility versus 6.5% by admitting health care professional, suggesting 37 high-risk patients were misclassified as low risk and were not prescribed thrombosis prophylaxis; 4 patients developed thromboembolic events. JH-HLM detected reduced mobility in 36% of thromboembolic cases, compared to 9% by admitting health care professionals. Conclusion
Initial mobility evaluations by admitting health care professionals during venous thromboembolism risk assessment may not reflect patient mobility over their hospital stay. This highlights the need for objective measures like JH-HLM in risk assessments to improve accuracy and potentially reduce thromboembolism incidents.
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