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December 1, 2017Mayo Clinic Proceedings Innovations Quality & OutcomesOpen Access

Venous Thromboembolism Prophylaxis: Inadequate and Overprophylaxis When Comparing Perceived Versus Calculated Risk

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Key result

Estimation of VTE risk based on clinical impression was congruent with calculated risk in only 54.9% of patients (40.8% low risk vs 72.1% high risk; P<.001), leading to frequent overtreatment.

Why the study?

Does clinical impression of VTE risk match calculated risk using the Padua Prediction Score in adult medical inpatients?

Population

437 consecutive adult patients admitted to general medical wards under medicine service between January 1…

Comparison

Clinical impression/documented risk for VTE… vs Calculated risk using the Padua Prediction Score

Design

Cohort

Authors

RCRahul ChaudharyADAbdulla A. DamlujiBBBhavina Batukbhai

Discussion

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Overview

Inappropriate VTE prophylaxis documentation was frequent in medical inpatients; hypothesis-generating for quality improvement efforts before practice change.

Study Design

Type

Observational (n=437)

Structured PICO

Does clinical impression of VTE risk match calculated risk using the Padua Prediction Score in adult medical inpatients?

P
Population
437 consecutive adult patients (≥18 years) admitted to general medical wards, evaluated for appropriateness of VTE prophylaxis.
E
Exposure
Clinical impression/documented risk for VTE prophylaxis
C
Comparator
Calculated risk using the Padua Prediction Score
O
Outcome
Appropriateness of risk stratification using the Padua Prediction Score

Main Result

Absolute Event Rate: 40.8% vs 72.1%

p-value: p=<.001

Clinical estimation of VTE risk is often incongruent with calculated risk models, leading to significant overtreatment and unnecessary costs, supporting the integration of VTE risk calculators in electronic health records.

Cite This Study

Chaudhary et al. (2017) conducted an observational in Venous thromboembolism (VTE) prophylaxis (n=437). Perceived VTE risk (clinical impression) vs. Calculated VTE risk (Padua Prediction Score) was evaluated on Appropriateness of risk stratification using the Padua Prediction Score (p=<.001). Estimation of VTE risk based on clinical impression was congruent with calculated risk in only 54.9% of patients (40.8% low risk vs 72.1% high risk; P<.001), leading to frequent overtreatment.

synapsesocial.com/papers/6a6add04ec7caa0664b3833chttps://doi.org/10.1016/j.mayocpiqo.2017.10.003
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Risk Factors for Venous Thrombotic Disease1999 · 379 citations
  2. 2Impact of a venous thromboembolism prophylaxis “smart order set”: Improved compliance, fewer events2013 · 105 citations
  3. 3Strategies to enhance venous thromboprophylaxis in hospitalized medical patients (SENTRY): a pilot cluster randomized trial2013 · 381 citations
  4. 4Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial2006 · 863 citations