Key result
The IMPROVE VTE risk assessment model demonstrated good discrimination (AUC 0.702) in identifying at-risk medical patients, with VTE rates of 1.29% for scores ≥3 versus 0.42% for scores ≤2.
Why the study?
Does the IMPROVE VTE risk assessment model accurately predict hospital-acquired VTE in a general medical population?
Cohort (n=19,217)
Does the IMPROVE VTE risk assessment model accurately predict hospital-acquired VTE in a general medical population?
The IMPROVE VTE risk assessment model successfully identifies hospitalized medical patients at low versus increased risk for VTE, potentially guiding targeted thromboprophylaxis.
May support VTE risk stratification in medical inpatients; leaves open need for outcome trials before practice change.
BACKGROUND: Hospitalized medical patients are at risk for venous thromboembolism (VTE). Universal application of pharmacological thromboprophylaxis has the potential to place a large number of patients at increased bleeding risk. In this study, we aimed to externally validate the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) VTE risk assessment model in a hospitalized general medical population. METHODS AND RESULTS: We identified medical discharges that met the IMPROVE protocol. Cases were defined as hospital-acquired VTE and confirmed by diagnostic study within 90 days of index hospitalization; matched controls were also identified. Risk factors for VTE were based on the IMPROVE risk assessment model (aged >60 years, prior VTE, intensive care unit or coronary care unit stay, lower limb paralysis, immobility, known thrombophilia, and cancer) and were measured and assessed. A total of 19 217 patients met the inclusion criteria. The overall VTE event rate was 0.7%. The IMPROVE risk assessment model identified 2 groups of the cohort by VTE incidence rate: The low-risk group had a VTE event rate of 0.42 (95% CI 0.31 to 0.53), corresponding to a score of 0 to 2, and the at-risk group had a VTE event rate of 1.29 (95% CI 1.01 to 1.57), corresponding to a score of ≥3. Low-risk status for VTE encompassed 68% of the patient cohort. The area under the receiver operating characteristic curve was 0.702, which was in line with the derivation cohort findings. CONCLUSIONS: The IMPROVE VTE risk assessment model validation cohort revealed good discrimination and calibration for both the overall VTE risk model and the identification of low-risk and at-risk medical patient groups, using a risk score of ≥3. More than two thirds of the entire cohort had a score ≤2.
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Rosenberg et al. (2014) conducted a cohort in Hospitalized medical patients at risk for venous thromboembolism (n=19,217). IMPROVE VTE risk assessment model was evaluated on Hospital-acquired VTE within 90 days of index hospitalization (AUC 0.702). The IMPROVE VTE risk assessment model demonstrated good discrimination (AUC 0.702) in identifying at-risk medical patients, with VTE rates of 1.29% for scores ≥3 versus 0.42% for scores ≤2.
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