Key result
The Cleveland Clinic Model showed poor discrimination for predicting 90-day VTE in medical inpatients, with 2.48% incidence in higher-risk vs. 1.91% in low-risk patients (P=0.52).
Why the study?
The Cleveland Clinic Model for VTE risk assessment in medical inpatients had never been independently validated and its prognostic accuracy compared with other RAMs.
Does the Cleveland Clinic Model accurately predict 90-day VTE risk in medical inpatients compared to the Padua Prediction Score and IMPROVE score?
Cohort (n=1,352)
Yes
Does the Cleveland Clinic Model accurately predict 90-day VTE risk in medical inpatients compared to the Padua Prediction Score and IMPROVE score?
Absolute Event Rate: 2.48% vs 1.91%
p-value: p=0.52
Current VTE risk assessment models, including the Cleveland Clinic Model, Padua Prediction Score, and IMPROVE score, show poor discrimination for predicting 90-day VTE in non-ICU medical inpatients.
BACKGROUND: Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in medical inpatients. The Cleveland Clinic Model (CCM), a novel risk assessment model (RAM) to guide thromboprophylaxis, has never been independently validated. OBJECTIVE: To validate and update the CCM, and compare its prognostic accuracy with the Padua Prediction Score (PPS) and the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) score. METHODS: We used data from a prospective cohort of medical inpatients admitted >24 h to general internal medicine wards at 3 Swiss university hospitals (06/2020-01/2022). The outcome was objectively confirmed symptomatic VTE within 90 days. Patients were stratified into higher and low VTE-risk groups by RAM. We compared test characteristics across 3 versions of the CCM (original CCM and 2 updated versions, 1 with a derived cut-off, and 1 modified derived cut-off version with 45-day follow-up and without missing variables), the PPS, and the IMPROVE score and drew calibration plots for the original and modified derived cut-off CCM. RESULTS: Of 1352 medical inpatients, 28 (2.1%) experienced VTE within 90 days. The 90-day VTE cumulative incidence was 2.48% in higher-risk vs. 1.91% in low-risk patients (P = 0.52) according to the original CCM. Discrimination was poor across all RAMs (areas under the receiver operating characteristics curve ≤60%). In calibration plots, the original and modified derived cut-off CCMs underestimated the VTE risk. CONCLUSION: In this non-U.S., non-ICU cohort, all RAMs showed comparable but limited accuracy for predicting VTE up to 90 days. Updating the original CCM did not improve predictive performance.
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Hofstetter et al. (2026) conducted a cohort in Venous thromboembolism (n=1,352). Cleveland Clinic Model (CCM) higher-risk classification vs. Cleveland Clinic Model (CCM) low-risk classification was evaluated on Objectively confirmed symptomatic VTE within 90 days (p=0.52). The Cleveland Clinic Model showed poor discrimination for predicting 90-day VTE in medical inpatients, with 2.48% incidence in higher-risk vs. 1.91% in low-risk patients (P=0.52).
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