title: External validation of a risk assessment model for venous thromboembolism in the hospitalised acutely-ill medical patient (VTE-VALOURR).
abstract: Venous thromboembolic (VTE) risk assessment remains an important issue in hospitalised, acutely-ill medical patients, and several VTE risk assessment models (RAM) have been proposed. The purpose of this large retrospective cohort study was to externally validate the IMPROVE RAM using a large database of three acute care hospitals. We studied 41,486 hospitalisations (28,744 unique patients) with 1,240 VTE hospitalisations (1,135 unique patients) in the VTE cohort and 40,246 VTE-free hospitalisations (27,609 unique patients) in the control cohort. After chart review, 139 unique VTE patients were identified and 278 randomly-selected matched patients in the control cohort. Seven independent VTE risk factors as part of the RAM in the derivation cohort were identified. In the validation cohort, the incidence of VTE was 0.20%; 95% confidence interval (CI) 0.18-0.22, 1.04%; 95%CI 0.88-1.25, and 4.15%; 95%CI 2.79-8.12 in the low, moderate, and high VTE risk groups, respectively, which compared to rates of 0.45%, 1.3%, and 4.74% in the three risk categories of the derivation cohort. For the derivation and validation cohorts, the total percentage of patients in low, moderate and high VTE risk occurred in 68.6% vs 63.3%, 24.8% vs 31.1%, and 6.5% vs 5.5%, respectively. Overall, the area under the receiver-operator characteristics curve for the validation cohort was 0.7731. In conclusion, the IMPROVE RAM can accurately identify medical patients at low, moderate, and high VTE risk. This will tailor future thromboprophylactic strategies in this population as well as identify particularly high VTE risk patients in whom multimodal or more intensive prophylaxis may be beneficial.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Mahan
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.forename: A Graham
authors.initials: AG
authors.lastname: Turpie
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Vu
authors.forename: Nancy
authors.initials: N
authors.lastname: Heddle
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cook
authors.forename: Undaleeb
authors.initials: U
authors.lastname: Dairkee
authors.affiliation: Alex C Spyropoulos, MD, FACP, FCCP, FRCPC, Director - Anticoagulation Services and Clinical Thrombosis, North Shore-LIJ Health System at Lenox Hill Hospital, Professor of Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, USA, Tel.: +1 212 434 6776, Fax: +1 212 434 6781, E-mail: aspyropoul@nshs.edu.
authors.forename: Alex C
authors.initials: AC
authors.lastname: Spyropoulos
mesh_terms: D000368:Aged; D002138:Calibration; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D054556:Venous Thromboembolism / Q000175:diagnosis*
chemical_list: D005343:Fibrinolytic Agents
keywords: Venous thromboembolism risk assessment; hospitalised medical patients; prevention; risk assessment models; validation