Pulmonary Vascular Disease |

Validating the IMPROVE Venous Thromboembolism (VTE) Risk Score: Retrospective Analysis of Electronic Data From a Large Health System FREE TO VIEW

David Rosenberg, MD; Ann Eichorn, MS; Mauricio Alarcon, BS; Lauren McCullagh, MPH; Alex Spyropoulos, MD
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Hofstra North Shore LIJ School of Medicine, Manhasset, NY

Chest. 2014;145(3_MeetingAbstracts):522A. doi:10.1378/chest.1836201
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SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Current VTE prophylaxis guidelines strongly promote risk assessment on the individual level. The IMPROVE VTE risk assessment model (RAM) is a composite score formulated to predict individual VTE risk during hospitalization. It is developed from a derivation cohort and has preliminary validation. This score sums 7 risk factors into risk categories: 0-1—Low Risk, 2-3—Moderate risk, >=4—high risk. In this study we aimed to validate the IMROVE VTE RAM using billing and EMR data from 2 tertiary medical centers in the North Shore-LIJ Health System

METHODS: We identified medical discharges (December 2009 - April 2013) that met the IMROVE protocol (principal discharge diagnosis of a medical illness (CHF, COPD exacerbation, infection, rheumatologic condition, cancer), length of stay >3, age >18, INR=< 1.5, no surgery 90 days prior, no full anticoagulation, no VTE 90 days prior, no obstetrical or psychiatric secondary diagnosis). Cases were defined as a hospital acquired VTE (based on ICD9s) and confirmed by diagnostic study; matched controls were also identified. Risk factors for VTE were measured (age > 60, prior VTE, ICU admission, paralysis, immobility, hypercoagulability, cancer history), and the IMPROVE RAM was assessed

RESULTS: 19,217 patients met inclusion and exclusion criteria. The VTE rate was 0.7%; with 135 cases and 405 controls. 3 risk factors were statistically association with the outcome: Age> 60 OR=1.76 95% CI (1.07-2.90), prior cancer 3.20, (2.10-4.86), prior VTE 3.23, (1.75, 5.96). The incidence rates and the 95% confidence intervals (CI) in the three risk groups were: Low risk: 0.33% (0.22-0.45); Moderate: 0.91% (0.69-1.13); High risk 1.51% (1.04-1.99).. The C-statistic (area under the ROC curve) was 0.702, suggesting a fair degree of discrimination.

CONCLUSIONS: This study, closely resembling the IMPROVE derivation cohort, supports that the 3 category RAM can reliably differentiate low risk patients from those at higher risk for a hospital acquired VTE.

CLINICAL IMPLICATIONS: It may be reasonable to withhold prophylaxis from low risk patients. Wide application of this RAM will require validation in a prospective study.

DISCLOSURE: David Rosenberg: Consultant fee, speaker bureau, advisory committee, etc.: Honorarium for consulting from Beohringer Ingelheim, Daiichi Sankyo , Grant monies (from industry related sources): Local PI on APEX trial, Portola The following authors have nothing to disclose: Ann Eichorn, Mauricio Alarcon, Lauren McCullagh, Alex Spyropoulos

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