New model accurately assesses VTE risk
NATIONAL HARBOR, Md. — A novel risk assessment model for venous thromboembolism accurately stratified risk among inpatients and demonstrated better discrimination than the Padua model which is currently recommended, according to data presented at Hospital Medicine 2019.
“We conducted the study because there were no venous thromboembolism (VTE) risk assessment models that were validated on U.S. medical inpatients,” Michael Rothberg, MD, from Cleveland Clinic, told Healio Primary Care Today. “VTE is an important problem, but many physicians prescribe prophylaxis based on their clinical judgment, which may lead to overtreatment.”
Rothberg and colleagues derived and validated a VTE risk assessment model using electronic health record data from a large sample of medical inpatients admitted to Cleveland Clinic hospitals between 2011 and 2016. The model used 16 variables to determine VTE risk, including age, sex, smoking status, history of VTE, thrombophilia, respiratory failure, chronic kidney disease, inflammatory arthritis, decubitus ulcer, cancer, acute infection, activity level, peripherally inserted central catheter, central line, mechanical ventilation and steroid use.
The accuracy of the model was compared with the Padua model.
The researchers evaluated a training set for the first 5 years (n = 98,661) and a validation set for the last year (n = 10,753).
In the training set, 0.2% of patients (n = 226) developed VTE in the hospital. There was a range in predicted risks from 0.03% to more than 28% in the training set.
In the validation set, 0.5% of patients (n = 55) developed VTE.
A quarter of patients were identified as high risk and three-quarters of patients were identified as low risk using the Cleveland Clinic model.
The model demonstrated a higher C-statistic than the Padua model (0.79 vs 0.63).
“Our risk model can accurately risk-stratify medical patients,” Rothberg said. “Most patients are actually low risk, with a risk of less than 0.25% in the hospital. If physicians did a better job of risk-stratifying patients based on objective measures, they would find that many patients do not require chemoprophylaxis.” – by Alaina Tedesco
Hamilton A, et al. Development and validation of a risk assessment model for VTE in hospitalized medical patients. Presented at: Hospital Medicine 2019; March 25-27; National Harbor, Md.
Disclosures: The study was funded by AHRQ. Rothberg reports no relevant financial disclosures.