title: Reliability of a point-based VTE risk assessment tool in the hands of medical residents.
abstract: BACKGROUND
  Venous thromboembolic events (VTE) are a significant cause of mortality in hospitalized medical and surgical patients. Despite recommendations and guidelines, current evidence demonstrates that VTE prophylaxis remains underutilized in at-risk patients. The process of providing VTE prophylaxis begins with assessing each patient's VTE risk. Using an individualized, point-based protocol in the assessment process is a complex task, and might contribute to variability in VTE prescribing behavior. There are no published data on how reliably residents can perform risk assessment and prophylaxis using a point-based VTE risk assessment tool.
  
  
  OBJECTIVE
  Our aim was to determine inter-rater reliability of a point-based risk assessment tool by residents early in the academic year.
  
  
  METHODS
  The design was a cross-sectional-cohort observational study.
  
  
  METHODS
  The site was an academic medical center.
  
  
  METHODS
  Case-based clinical vignettes were used.
  
  
  METHODS
  Verbal instructions were given to medical residents about how to apply our hospital's point-based VTE risk assessment tool.
  
  
  METHODS
  Interobserver agreement was measured of: 1) risk score, 2) risk-stratification, 3) identification of contraindications, 4) VTE prophylaxis plan, and 5) resident adherence to the protocol.
  
  
  RESULTS
  The intra-class correlation (ICC) for the total risk score was 0.66 and the kappa coefficient for risk stratification was 0.51. The kappa scores for absolute and relative contraindications were 0.29 and 0.23, respectively. The kappa score for the VTE plan was 0.28.
  
  
  CONCLUSIONS
  We determined that, following brief instructions early in the academic year, a point-based VTE risk assessment tool has only fair to moderate inter-rater reliability, with suboptimal adherence to the protocol. Both might lead to underutilization of VTE prevention strategies.
authors.affiliation: Department of Pediatrics, The Milton S. Hershey Medical Center and the Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA. mbeck@HMC.PSU.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beck
authors.forename: Paul
authors.initials: P
authors.lastname: Haidet
authors.forename: Krista
authors.initials: K
authors.lastname: Todoric
authors.forename: Erik
authors.initials: E
authors.lastname: Lehman
authors.forename: Chris
authors.initials: C
authors.lastname: Sciamanna
mesh_terms: D015331:Cohort Studies; D003430:Cross-Sectional Studies; D006760:Hospitalization; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000175:diagnosis* / Q000209:etiology