Immobilization is known to be an important contributing factor to venous thromboembolism (VTE). However, the currently available risk assessment models for VTE in hospitalized medical patients use variable definitions of reduced mobility that are difficult to standardize and to apply prospectively. We sought to evaluate the physician’s ability to determine at the time of admission whether a patient will have reduced mobility for at least 3 days.
Physicians were asked to complete a standard data collection tool during their initial evaluation of patients admitted to the general medical units of an 805‐bed teaching hospital. The tool captured baseline demographic data and clinical variables included in the Padua Risk Assessment Model (PRAM). To assess mobility status, physicians were asked whether they anticipate reduced mobility for at least 3 days that is limited to no more than bed rest with bathroom privileges. This was later compared to the patient’s actual ability to ambulate independently on the 3rdhospital day as determined by the patient’s nurse.
Of the 351 patients enrolled in the study, 123 (35%) were expected to have reduced mobility by their admitting physician and 154 (44%) were considered high‐risk for VTE based on a PRAM score of ≥ 4. Among those high‐risk for VTE, 111 (72%) were expected to have reduced mobility, while only 12 (6%) of those who were low‐risk were anticipated to be immobile (p<0.0001). The physician’s prediction at the time of admission of the patient’s reduced mobility during hospitalization had a sensitivity of 76% (95% Confidence Interval [CI], 66% to 84%) and a specificity of 81% (95%CI, 75% to 86%). The positive and negative predictive values were 62% (95%CI, 52% to 71%) and 89% (95%CI, 84% to 93%), respectively.
The physician’s anticipation of patient’s reduced mobility is fairly reliable in predicting actual mobility during hospitalization. This may be used to standardize the operational definition of reduced mobility when assessing a patient’s risk of VTE.
To cite this abstract:Weick A, Paje D, Small B, Usman M, Shah J, Behrendt R. Standardizing the Definition of Reduced Mobility When Assessing a Patient’s Risk of Venous Thromboembolism. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 145. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/standardizing-the-definition-of-reduced-mobility-when-assessing-a-patients-risk-of-venous-thromboembolism/. Accessed April 4, 2020.