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Inicio Medicina Clínica (English Edition) Concordance among venous thromboembolism risk assessment models
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Vol. 150. Issue 2.
Pages 61-63 (January 2018)
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Vol. 150. Issue 2.
Pages 61-63 (January 2018)
Brief report
Concordance among venous thromboembolism risk assessment models
Concordancia entre las escalas de predicción de riesgo tromboembólico venoso
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Clara Smilg Nicolás, Gloria Tornel Sánchez, Javier Trujillo Santos
Corresponding author
javier.trujillosantos@gmail.com

Corresponding author.
Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
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Tables (3)
Table 1. Demographic data and risk factors of the study patients.
Table 2. VTE risk calculated according to the different scales, prophylaxis received according to the risk groups and VTE observed according to the calculated risk and the prophylaxis received.
Table 3. Kappa index of agreement observed between the different VTE risk assessment scales.
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Abstract
Background and objectives

There are a lot of venous thromboembolism risk assessment models with the aim of predicting the individual risk of venous thromboembolism (VTE), although most have not been externally validated. The objective of our study was to analyze the concordance among the Padua, PRETEMED, IMPROVE and MEDENOX scores.

Patients and methods

Observational cohort study with 602 patients admitted to Medical Services of the Hospital Universitario Santa Lucía. Concordance was calculated using the kappa index (KI) between the four risk prediction scales and the VTE occurring within 90 days of hospitalization.

Results

Patients considered were those with a high risk of VTE, 78%, 56%, 69% and 59% according to Padua, PRETEMED, IMPROVE and MEDENOX scores respectively. A KI=0.60 was observed among Padua-IMPROVE scores; KI=0.44 among IMPROVE-PRETEMED, KI=0.43 among PRETEMED-MEDENOX, KI=0.33 among Padua-PRETEMED, KI=0.27 among IMPROVE-MEDENOX and a KI=0.24 among Padua-MEDENOX. During follow-up, nine cases of VTE (1.5%) were observed.

Conclusions

The highest degree of agreement was observed among the Padua and IMPROVE scores. There is no good agreement between any of the predictive risk scales for VTE in medical patients. The Padua score was the best predictor of VTE episodes at 90 days among high risk patients.

Keywords:
Venous thromboembolism risk assessment models
Venous thromboembolic disease
Thromboprophylaxis
Resumen
Antecedentes y objetivos

Existen numerosas escalas cuyo objetivo es predecir el riesgo individual de enfermedad tromboembólica venosa (ETV), si bien la mayoría de ellas no se han validado externamente. El objetivo de nuestro estudio fue analizar la concordancia entre las escalas de Padua, PRETEMED, IMPROVE y los criterios de inclusión del estudio MEDENOX.

Pacientes y método

Estudio observacional de cohortes con 602 pacientes ingresados en servicios médicos del Hospital Universitario Santa Lucía. Se calculó la concordancia mediante el índice kappa (IK) entre las 4 escalas de predicción de riesgo y se recogieron las ETV ocurridas en los 90 días siguientes a la hospitalización.

Resultados

Se consideraron pacientes de alto riesgo de presentar ETV el 78, 56, 69 y 59% de los pacientes según las escalas Padua, PRETEMED, IMPROVE y MEDENOX, respectivamente. Se observó un IK=0,60 entre las escalas Padua-IMPROVE; IK=0,44 entre IMPROVE-PRETEMED, IK=0,43 entre PRETEMED-MEDENOX, IK=0,33 entre Padua-PRETEMED, IK=0,27 entre IMPROVE-MEDENOX y un IK=0,24 entre Padua-MEDENOX. Durante el seguimiento se observaron 9 casos de ETV (1,5%).

Conclusiones

El mayor grado de concordancia se determinó entre las escalas Padua e IMPROVE. No existe buena concordancia entre ninguna de las escalas de predicción de riesgo de ETV en pacientes médicos. La escala Padua fue la que mejor predijo los episodios de ETV a los 90 días entre los pacientes clasificados de alto riesgo.

Palabras clave:
Escala de predicción de riesgo
Enfermedad tromboembólica venosa
Tromboprofilaxis

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