An electronic tool for venous thromboembolism prevention in medical and surgical patients.

Abstract : BACKGROUND AND OBJECTIVES: Venous thromboembolism (VTE) is a complex disorder influenced by numerous risk factors, and occurs frequently in at-risk hospitalized patients. Because appropriate prevention with thromboprophylaxis is underused, we wanted to create an electronic tool to provide a simple risk assessment and suggest appropriate prophylaxis. DESIGN AND METHODS: To develop the risk matrix, iterative rating of odds ratios was performed for 60 predisposing VTE risk factors, using analytical methods that account for multiple risk factors in a single patient and their non-independence. For exposing risk factors, a single score was assigned to each set of factors, both medical (25 items) and surgical conditions (144 items). A CART regression model was used to integrate the risk scales into a 4-level measure of overall risk. The validity of the level of risk and the appropriateness of 11 different prophylactic approaches was assessed using the RAND/UCLA appropriateness method and validated by expert opinion ratings (n=1998) on sample case scenarios (n=108). RESULTS: Correlation between the level of risk calculated by the risk matrix and that offered by expert opinion for individual surgical and medical clinical cases was high (65% and 70%, respectively). The matrix over-estimated the level of risk, compared with that offered by expert opinion, in 28% and 20% of surgical and medical cases, respectively, but the appropriate prophylaxis suggested was no different. Between-expert agreement on the appropriateness of the prophylaxis recommendations was high (90-94% of indications). INTERPRETATION AND CONCLUSIONS: This computer-based electronic tool for individualized assessment of venous thromboembolic risk successfully identified both the perceived risk of thrombosis and the appropriate prophylactic approach for medical and surgical patients.
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Article dans une revue
Haematologica, Ferrata Storti Foundation, 2006, 91 (1), pp.64-70
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https://hal-ujm.archives-ouvertes.fr/ujm-00439794
Contributeur : Patrick Mismetti <>
Soumis le : mardi 8 décembre 2009 - 15:32:52
Dernière modification le : dimanche 15 octobre 2017 - 22:44:04

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  • HAL Id : ujm-00439794, version 1
  • PUBMED : 16434372

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Meyer-Michel Samama, Ola E Dahl, Patrick Mismetti, Daniel J Quinlan, Nadia Rosencher, et al.. An electronic tool for venous thromboembolism prevention in medical and surgical patients.. Haematologica, Ferrata Storti Foundation, 2006, 91 (1), pp.64-70. 〈ujm-00439794〉

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