External validation of the IMPROVE Bleeding Risk Assessment Model in medical patients.
The IMPROVE Bleed Risk Assessment Model (RAM) remains the only bleed RAM in hospitalised medical patients using 11 clinical and laboratory factors. The aim of our study was to externally validate the IMPROVE Bleed RAM. A retrospective chart review was conducted between October 1, 2012 and July 31, 2014. We applied the point scoring system to compute risk scores for each patient in the validation sample. We then dichotomised the patients into those with a score <7 (low risk) vs ≥ 7 (high risk), as outlined in the original study, and compared the rates of any bleed, non-major bleed, and major bleed. Among the 12,082 subjects, there was an overall 2.6 % rate of any bleed within 14 days of admission. There was a 2.12 % rate of any bleed in those patients with a score of < 7 and a 4.68 % rate in those with a score ≥ 7 [Odds Ratio (OR) 2.3 (95 % CI=1.8-2.9), p<0.0001]. MB rates were 1.5 % in the patients with a score of < 7 and 3.2 % in the patients with a score of ≥ 7, [OR 2.2 (95 % CI=1.6-2.9), p<0.0001]. The ROC curve was 0.63 for the validation sample. This study represents the largest externally validated Bleed RAM in a hospitalised medically ill patient population. A cut-off point score of 7 or above was able to identify a high-risk patient group for MB and any bleed. The IMPROVE Bleed RAM has the potential to allow for more tailored approaches to thromboprophylaxis in medically ill hospitalised patients.
David J
DJ
Rosenberg
Anne
A
Press
Joanna
J
Fishbein
Martin
M
Lesser
Lauren
L
McCullagh
Thomas
T
McGinn
Alex C. Spyropoulos, MD, FACP, FCCP, FRCPC, Hofstra, North Shore - LIJ School of Medicine, Lenox Hill Hospital, 130 E 77th St, New York, NY 10075, USA, Tel.: +1 212 434 6776, Fax: +1 212 434 6781, E-mail: aspyropoul@nshs.edu.
Alex C
AC
Spyropoulos
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D054556:Venous Thromboembolism / Q000517:prevention & control*
Risk Assessment Model; anticoagulants; bleeding risk; medical patients; validation