title: Predictive and associative models to identify hospitalized medical patients at risk for VTE.
abstract: BACKGROUND
  Acutely ill hospitalized medical patients are at risk for VTE. We assessed the incidence of VTE in the observational International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) study and derived VTE risk assessment scores at admission and associative VTE scores during hospitalization.
  
  
  METHODS
  Data from 15,156 medical patients were analyzed to determine the cumulative incidence of clinically observed VTE over 3 months after admission. Multiple regression analysis identified factors associated with VTE risk.
  
  
  RESULTS
  Of the 184 patients who developed symptomatic VTE, 76 had pulmonary embolism, and 67 had lower-extremity DVT. Cumulative VTE incidence was 1.0%; 45% of events occurred after discharge. Factors independently associated with VTE were previous VTE, known thrombophilia, cancer, age > 60 years, lower-limb paralysis, immobilization ≥ 7 days, and admission to an ICU or coronary care unit (first four were available at admission). Points were assigned to each factor identified to give a total risk score for each patient. At admission, 67% of patients had a score ≥ 1. During hospitalization, 31% had a score ≥ 2; for a score of 2 or 3, observed VTE risk was 1.5% vs 5.7% for a score ≥ 4. Observed and predicted rates were similar for both models (C statistic, 0.65 and 0.69, respectively). During hospitalization, a score ≥ 2 was associated with higher overall and VTE-related mortality.
  
  
  CONCLUSIONS
  Weighted VTE risk scores derived from four clinical risk factors at hospital admission can predict VTE risk in acutely ill hospitalized medical patients. Scores derived from seven clinical factors during hospitalization may help us to further understand symptomatic VTE risk. These scores require external validation.
authors: Hamilton Health Sciences General Hospital, McMaster University, Hamilton, ON, Canada. Electronic address: spyropa@mcmaster.ca.
authors: Alex C
authors: AC
authors: Spyropoulos
authors: Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA.
authors: Frederick A
authors: FA
authors: Anderson
authors: Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA.
authors: Gordon
authors: G
authors: FitzGerald
authors: INSERM, CIE3, Saint-Etienne, University Saint-Etienne, CHU Saint-Etienne, Hôpital Nord, Service de Médecine Interne et Thérapeutique, Saint-Etienne, France.
authors: Herve
authors: H
authors: Decousus
authors: Medicina Interna II, Fidenza Hospital, Parma, Italy.
authors: Mario
authors: M
authors: Pini
authors: St. George Clinical School, University of New South Wales, Sydney, NSW, Australia.
authors: Beng H
authors: BH
authors: Chong
authors: Hämostase-Institut Düsseldorf, Düsseldorf, Germany.
authors: Rainer B
authors: RB
authors: Zotz
authors: Hôpital Lariboisiere Clinique Thérapeutique, University Paris Diderot, Paris, France.
authors: Jean-François
authors: JF
authors: Bergmann
authors: Duke University Medical Center, Durham, NC.
authors: Victor
authors: V
authors: Tapson
authors: Vascular Medicine, University of Michigan Health System, Ann Arbor, MI.
authors: James B
authors: JB
authors: Froehlich
authors: Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Badalona, Spain.
authors: Manuel
authors: M
authors: Monreal
authors: Jefferson Vascular Diseases Center, Departments of Surgery and Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.
authors: Geno J
authors: GJ
authors: Merli
authors: Hospital do Coracao Clinica Medica São Paulo, São Paulo, Brazil.
authors: Ricardo
authors: R
authors: Pavanello
authors: Hamilton Health Sciences General Hospital, McMaster University, Hamilton, ON, Canada.
authors: Alexander G G
authors: AGG
authors: Turpie
authors: Department of Cardiology, Mie University Graduate School of Medicine, Tsu Mie, Japan.
authors: Mashio
authors: M
authors: Nakamura
authors: U.O. Angiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors: Franco
authors: F
authors: Piovella
authors: Thrombosis Research Institute and University College London, London, England.
authors: Ajay K
authors: AK
authors: Kakkar
authors: Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.
authors: Frederick A
authors: FA
authors: Spencer
mesh_terms: D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000517:prevention & control