Validating the Improve Venous Thromboembolism (Vte) Risk Score: Retrospective Analysis of Electronic Data from a Large Health System

1Hofstra North Shore‐LIJ School of Medicine, North Shore University Hospital, Manhasset, NY
2North Shore LIJ Health System, New Hyde PArk, NY
3North Shore LIJ Health System, Melville, NY
4North Shore LIj Health System, Manhasset, NY
5Hofstra North Shore‐LIJ School of Medicine, Manhasset, NY

Meeting: Hospital Medicine 2014, March 24-27, Las Vegas, Nev.

Abstract number: 67

Background:

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.

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. With this, it may be reasonable to withhold prophylaxis from low risk patients. Wide application of this RAM will require validation in a prospective study.

To cite this abstract:

Rosenberg D, Eichorn A, Alarcon M, McCullagh L, Spyropoulos A. Validating the Improve Venous Thromboembolism (Vte) Risk Score: Retrospective Analysis of Electronic Data from a Large Health System. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 67. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/validating-the-improve-venous-thromboembolism-vte-risk-score-retrospective-analysis-of-electronic-data-from-a-large-health-system/. Accessed May 23, 2019.

« Back to Hospital Medicine 2014, March 24-27, Las Vegas, Nev.