Summary

Concordance between risk scales for venous thromboembolism in patients treated in emergency departments

Mónica Olid Velilla1, Sònia Jiménez Hernández2, Fahd Beddar3,4, Vanesa Sendín Martín5, Línder Cárdenas Bravo6, Ángel Álvarez Márquez7, Daniel Sánchez Díaz-Canel8, Susana Diego Roza9, Ángel Sánchez Garrido-Lestache10, David Jiménez Castro11-13, Ramón Lecumberri14,15, Pedro Ruiz Artacho1,13,16, en representación del Grupo de trabajo de Enfermedad Tromboembólica Venosa de la Sociedad Española de Medicina de Urgencias y Emergencias (ETV-SEMES)

Affiliation of the authors

1Departamento de Medicina Interna, Clínica Universidad de Navarra, Madrid, Spain. 2Área de Urgencias, Hospital Clinic, IDIBAPS, Barcelona, Spain. 3Servicio de Urgencias, Complejo Asistencial de Soria, Spain. 4Universidad de Valladolid, Facultad de Ciencias de la Salud, Valladolid, Spain. 5Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, Spain. 6Servicio de Urgencias, Hospital Reina Sofía, Murcia. Spain. 7Servicio de Urgencias, Hospital Universitario Nuestra Señora de Valme, Sevilla, Spain. 8Servicio de Urgencias, Hospital Universitario La Ribera, Valencia, Spain. 9Servicio de Urgencias, Hospital Valle de Nalón, Oviedo, Spain. 10Servicio de Urgencias, Hospital General de Albacete, Albacete, Spain.11Servicio de Neumología, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain. 12Departamento de Medicina, Universidad de Alcalá, Madrid, Spain. 13CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain. 14Servicio de Hematología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. 15CIBER-CV, Madrid, Spain. 16Interdisciplinar Teragnosis and Radiosomics (INTRA) Research Group, Universidad de Navarra, Spain.

DOI

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Olid Velilla M, Jiménez Hernández S, Beddar F, Sendín Martín V, Cárdenas Bravo L, Álvarez Márquez A, et al. Concordance between risk scales for venous thromboembolism in patients treated in emergency departments. Emergencias. 2024;36:342-50

Summary

Objectives.

To evaluate agreement between risk-assessment models for venous thromboembolism (VTE) in patients hospitalized for medical conditions and to analyze variables associated with the decision to prescribe pharmacological thromboprophylaxis in hospital emergency departments (EDs).

Methods.

Prospective observational multicenter cohort study. We included adults attended in 15 hospital EDs who were hospitalized for medical conditions, calculating VTE risk according to the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) score, the Padua Prediction Score (PPS), and the National Institute for Health and Care Excellence (NICE) score. In addition to assessing interscore concordance, we analyzed variables associated with the prescription of thromboprophylaxis in the ED.

Results.

A total of 1203 patients were included. The PADUA, IMPROVE, and NICE scales assigned high risk scores for 68.7%, 47.4%, and 69.5% of the patients, respectively. The κ statistic for agreement between the PADUA and NICE scores was 0.80 (95% CI, 0.76-0.84); 102 patients (8.5%) had discordant scores. The κ statistics for agreement between the IMPROVE score and the PADUA and NICE classifications were 0.47 (95% CI, 0.43-0.52) and 0.37 (95% CI, 0.33-0.42), respectively; 322 (26.8%) and 384 patients (31.9%), respectively, had discordant scores. Variables associated with starting thromboprophylaxis in the ED were a diagnosis of acute myocardial infarction or stroke (adjusted odds ratio [aOR], 4.26), immobility in the last 2 months (aOR, 2.19), chronic obstructive pulmonary disease (aOR, 1.97), ischemic heart disease (aOR, 1.51), reduced mobility of 3 days or longer (aOR, 1.14), body mass index (aOR, 1.04), age (aOR, 1.02), recent trauma or surgery (aOR, 0.40), and risk for bleeding (aOR, 0.56).

Conclusions.

There is disagreement among the recommended models for predicting risk for VTE in patients hospitalized for medical conditions. The basis for emergency physicians’ clinical judgment regarding thromboprophylaxis extends beyond risk scales to include multiple risk factors for VTE and bleeding.

 

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