Validation of risk assessment models predicting venous thromboembolism in acutely ill medical inpatients: A cohort study

Abstract

Background Because hospital‐acquired venous thromboembolism (VTE) represents a frequent cause of preventable deaths in medical inpatients, identifying at‐risk patients requiring thromboprophylaxis is critical. We aimed to externally assess the Caprini, IMPROVE, and Padua VTE risk scores and to compare their performance to advanced age as a stand‐alone predictor. Methods We performed a retrospective analysis of patients prospectively enrolled in the PREVENU trial. Patients aged 40 years and older, hospitalized for at least 2 days on a medical ward were consecutively enrolled and followed for 3 months. Critical ill patients were not recruited. Patients diagnosed with VTE within 48 hours from admission, or receiving full dose anticoagulant treatment or who underwent surgery were excluded. All suspected VTE and deaths occurring during the 3‐month follow‐up were adjudicated by an independent committee. The three scores were retrospectively assessed. Body mass index, needed for the Padua and Caprini scores, was missing in 44% of patients. Results Among 14 910 eligible patients, 14 660 were evaluable, of which 1.8% experienced symptomatic VTE or sudden unexplained death during the 3‐month follow‐up. The area under the receiver operating characteristic curves (AUC) were 0.60 (95% confidence interval [CI] 0.57‐0.63), 0.63 (95% CI 0.60‐0.66) and 0.64 (95% CI 0.61‐0.67) for Caprini, IMPROVE, and Padua scores, respectively. None of these scores performed significantly better than advanced age as a single predictor (AUC 0.61, 95% CI 0.58‐0.64). Conclusion In our study, Caprini, IMPROVE, and Padua VTE risk scores have poor discriminative ability to identify not critically ill medical inpatients at risk of VTE, and do not perform better than a risk evaluation based on patient's age alone.

Prevention, Diagnosis, and Treatment of VTE in Patients With Coronavirus Disease 2019

“…[28][29][30] Because the incidence of VTE in acutely ill medical inpatients is too low (below 1% without thromboprophylaxis) to justify anticoagulant thromboprophylaxis-and incurred risk of bleeding-in every patient, 19 several risk stratification scores have been developed to identify medical inpatients at higher risk of VTE. The Padua and IMPROVE risk scores are the most extensively validated scores 31,32 but both showed heterogeneous discriminatory performance in external validation studies [32][33][34][35][36][37][38][39][40][41] and they lack validation in an impact study.…”

Validation of Risk Assessment Models Predicting Venous Thromboembolism in Inpatients with Acute Exacerbation Of Chronic Obstructive Pulmonary Disease: A Multicenter Cohort Study in China

“…First, the validity of the Padua and Caprini RAMs in inpatients with AECOPD has not been previously evaluated. Some studies tried to validate the Padua or Caprini RAM in medical patients; however, a consensus was not reached, which might be attributed to different study populations and small sample sizes in some studies 28,31,[33][34][35] . For example, Grant et al tried to assess the Caprini RAM for the risk assessment of VTE in 63,584 inpatients in non-intensive-care units 28 .…”

Padua Prediction Score was Inappropriate for Venous Thromboembolism Risk Assessment in Acute Medical Inpatients: A Cohort Study

“…Systematic screening of hospitalized patients for the occurrence of VTE resulted in a more realistic incidence and decreased misdiagnosis of asymptomatic patients. That's also the main reason why the overall VTE incidence of our study is higher than other researches worldwide [31][32][33].…”