Validation of the Caprini Venous Thromboembolism Risk Assessment Model in Critically Ill Surgical Patients.
OBJECTIVE
Appropriate risk stratification for venous thromboembolism (VTE) is essential to providing appropriate thromboprophylaxis and avoiding morbidity and mortality.


OBJECTIVE
To validate the Caprini VTE risk assessment model in a previously unstudied high-risk cohort: critically ill surgical patients.


METHODS
We performed a retrospective cohort study of 4844 adults (≥18 years old) admitted to a 20-bed surgical intensive care unit in a large tertiary care academic hospital during a 5-year period (July 1, 2007, through June 30, 2012).


METHODS
The main study outcome was VTE (defined as patients with deep vein thrombosis or pulmonary embolism) that occurred during the patient's initial hospital admission.


RESULTS
The study population was distributed among risk levels as follows: low, 5.3%; moderate, 19.9%; high, 31.6%; highest, 25.4%; and superhigh, 14.9%. The overall incidence of inpatient VTE was 7.5% and increased with risk level: 3.5% in low-risk patients, 5.5% in moderate-risk patients, 6.6% in high-risk patients, 8.6% in highest-risk patients, and 11.5% in superhigh-risk patients. Patients with Caprini scores greater than 8 were significantly more likely to develop inpatient VTE events when compared with patients with Caprini scores of 7 to 8 (odds ratio [OR], 1.37; 95% CI, 1.02-1.85; P = .04), 5 to 6 (OR, 1.35; 95% CI, 1.16-1.57; P < .001), 3 to 4 (OR, 1.30; 95% CI, 1.16-1.47; P < .001), or 0 to 2 (OR, 1.37; 95% CI, 1.16-1.64; P < .001). Similarly, patients with Caprini scores of 7 to 8 were significantly more likely to develop inpatient VTE when compared with patients with Caprini scores of 5 to 6 (OR, 1.33; 95% CI, 1.01-1.75; P = .04), 3 to 4 (OR, 1.27; 95% CI, 1.08-1.51; P = .005), or 0 to 2 (OR, 1.38; 95% CI, 1.10-1.74; P = .006).


CONCLUSIONS
The Caprini VTE risk assessment model is valid. This study supports the use of individual risk assessment in critically ill surgical patients.
Section of Vascular Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor.
Andrea T
AT
Obi
Division of Plastic Surgery, Department of Surgery, University of Utah, Salt Lake City.
Christopher J
CJ
Pannucci
West Virginia School of Osteopathic Medicine, Lewisburg.
Andrew
A
Nackashi
Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan.
Newaj
N
Abdullah
Office of Performance Assessment and Clinical Effectiveness, University of Michigan Health System, Ann Arbor.
Rafael
R
Alvarez
Office of Performance Assessment and Clinical Effectiveness, University of Michigan Health System, Ann Arbor.
Vinita
V
Bahl
Office of Performance Assessment and Clinical Effectiveness, University of Michigan Health System, Ann Arbor.
Thomas W
TW
Wakefield
Office of Performance Assessment and Clinical Effectiveness, University of Michigan Health System, Ann Arbor.
Peter K
PK
Henke
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D013514:Surgical Procedures, Operative; D054556:Venous Thromboembolism / Q000453:epidemiology*