title: An electronic tool for venous thromboembolism prevention in medical and surgical patients.
abstract: OBJECTIVE
  Venous thromboembolism (VTE) is a complex disorder influenced by numerous risk factors, and occurs frequently in at-risk hospitalized patients. Because appropriate prevention with thromboprophylaxis is underused, we wanted to create an electronic tool to provide a simple risk assessment and suggest appropriate prophylaxis.
  
  
  METHODS
  To develop the risk matrix, iterative rating of odds ratios was performed for 60 predisposing VTE risk factors, using analytical methods that account for multiple risk factors in a single patient and their non-independence. For exposing risk factors, a single score was assigned to each set of factors, both medical (25 items) and surgical conditions (144 items). A CART regression model was used to integrate the risk scales into a 4-level measure of overall risk. The validity of the level of risk and the appropriateness of 11 different prophylactic approaches was assessed using the RAND/UCLA appropriateness method and validated by expert opinion ratings (n=1998) on sample case scenarios (n=108).
  
  
  RESULTS
  Correlation between the level of risk calculated by the risk matrix and that offered by expert opinion for individual surgical and medical clinical cases was high (65% and 70%, respectively). The matrix over-estimated the level of risk, compared with that offered by expert opinion, in 28% and 20% of surgical and medical cases, respectively, but the appropriate prophylaxis suggested was no different. Between-expert agreement on the appropriateness of the prophylaxis recommendations was high (90-94% of indications).
  
  
  CONCLUSIONS
  This computer-based electronic tool for individualized assessment of venous thromboembolic risk successfully identified both the perceived risk of thrombosis and the appropriate prophylactic approach for medical and surgical patients.
authors.affiliation: Hôtel-Dieu, Paris, France. florence.roux@htd.ap-hop-paris.fr
authors.forename: Meyer-Michel
authors.initials: MM
authors.lastname: Samama
authors.forename: Ola E
authors.initials: OE
authors.lastname: Dahl
authors.forename: Patrick
authors.initials: P
authors.lastname: Mismetti
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Quinlan
authors.forename: Nadia
authors.initials: N
authors.lastname: Rosencher
authors.forename: Marleen
authors.initials: M
authors.lastname: Cornelis
authors.forename: Han
authors.initials: H
authors.lastname: de Vries
authors.forename: Ineke
authors.initials: I
authors.lastname: van Beusekom
authors.forename: James P
authors.initials: JP
authors.lastname: Kahan
mesh_terms: D000465:Algorithms; D003661:Decision Support Techniques; D003936:Diagnosis, Computer-Assisted; D006801:Humans; D011292:Premedication; D018570:Risk Assessment; D013923:Thromboembolism / Q000175:diagnosis / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000517:prevention & control*