Predictive value of three kinds of thrombosis risk assessment scale for lower extremity deep vein thrombosis after hip fracture in elderly patients / 中国骨伤

OBJECTIVE@#To explore predictive value of Caprini score, Wells score and Autar score for lower extremity deep vein thrombosis (DVT) after hip fracture in elderly patients.@*METHODS@#A total of 310 elderly patients with hip fracture were selected from January 2018 to September 2022. According to the lower extremity color ultrasound examination results, 155 patients with DVT were divided into thrombosis group, included 42 males and 113 females, aged from 60 to 101 years old with an average of (80.58±8.84) years old; and 155 patients without DVT were divided into control group, included 58 males and 97 females, aged from 60 to 94 years old with an average of (79.01±8.99) years old. Caprini score, Wells score and Autar score immediately after admission were collected and compared between two groups. Receiver operating characteristic (ROC) curve was used to evaluate predictive value of three thrombus risk assessment tables for DVT after hip fracture in elderly patients.@*RESULTS@#Caprini score, Wells score and Autar score in thrombus group were significantly higher than those in control group (P<0.001). ROC curve analysis results showed that the best cut-off value of Caprini score was 8.5 points, the sensitivity was 46.5%, the specificity was 99.4%, and area under the curve(AUC) was 0.763. The best cut-off value of Wells score was 1.5, the sensitivity was 100%, the specificity was 99.4%, and AUC was 0.998. The best cut-off value of Autar score was 10.5 points, the sensitivity was 58.1%, the specificity was 84.5%, and AUC was 0.717.@*CONCLUSION@#Caprini scale, Wells scale and Autar scale all have good predictive efficacy for the risk of DVT in elderly patients with hip fracture, and could provide an important reference for clinical guidance for prevention, management and treatment of DVT after hip fracture in elderly patients, among which Wells scale has a higher predictive value.

Enfermedad tromboembólica venosa: factores de riesgo y profilaxis en pacientes hospitalizados / Venous thromboembolic disease: risk factors and prophylaxis in hospitalized patients

Un alto porcentaje de pacientes hospitalizados puede presentar trombosis venosa profunda con sus corresponientes consecuencias. Objetivos: Determinar el riesgo y tratamiento profiláctico de enfermedad tromboembólica venosa (ETEV) en pacientes hospitalizados. Métodos:investigación de tipo observacional, transversal y multicéntrica. Se aplicó la escala de Caprini para identificar factores de riesgo en pacientes hospitalizados de cuatro hospitales del área Metropolitana de Caracas. Por otra parte, se aplicó una encuesta a médicos residentes y especialistas de las distintas sedes hospitalarias para determinar su conocimiento en profilaxis para ETEV. Resultados: Se registraron 851 pacientes hospitalizados con edad 48,6 + 19,3 años, con predominio del género masculino (59 %). Estaban en servicios quirúrgicos 489 pacientes (57,5 %) y servicios médicos 362 pacientes (42,5 %). Según la escala de Caprini 154 pacientes (18,1 %) estaban en riesgo moderado, y 642 pacientes (75,4 %) en riesgo alto. Recibieron tratamiento profiláctico 61 pacientes (7,7 %), siendo la medicación y la dosis adecuada solo en el 32,8 % de estos pacientes. En cuanto al conocimiento de ETEV, el 96,9 % de los médicos conoce la enfermedad, pero solo el 58,5 % reconoce la embolia pulmonar como parte de esta entidad. Solo el 49,2 % de los encuestados conoce o aplica escalas de riesgo para esta enfermedad. El tratamiento farmacológico es conocido por el 93,8 % de los médicos. Solo el 56,6 % de los médicos realiza seguimiento a los pacientes, siendo el lapso menor de 3 meses el más frecuente (40 %). Conclusiones: en nuestro estudio hay predominio de pacientes con alto riesgo para ETEV. El uso de profilaxis farmacológica es muy bajo. El conocimiento de escalas de riesgo no es adecuado(AU)

Venous thromboembolic disease is frequent in hospitalized patients.Objectives: To determine the risk and prophylactic therapy of venous thromboembolic disease (VTE) in patients with medical and surgical pathologies according to the Caprini scale. Methods: an observational, transversal and multicenter research was performed. The Caprini scale was applied to identify risk factors in medical and surgical hospitalized patients of four hospitals in the metropolitan area of Caracas. Also, a survey was applied to residents and specialists from the different hospitals to determine the knowledge about prophylactic treatment for VTE. Results: we registered 851 hospitalized patients with an age of 48,6 + 19,3 years, mainly men (59 %). There were 489 surgical patients (57,5 %) and 362 medical patients (42,5 %). According to Caprini risk scale 154 patients (18,1 %) were at middle risk and 642 patients (75,4 %) were at high risk. Prophylactic treatment was indicated in 61 patients (7,7 %), this treatment was adequate (doses and drug type) only in 32 % of these patients. About the ETV, 96,9 % of the medical doctors had knowledge of this illness, but only 58,5 % recognize pulmonary embolism as part of this entity. Only 49,2 % knows or applies risk scales for ETV. 56,6 % follows the patients, more frequently for less of 3 months (40 %). Conclusions: we found is a high predominance of moderate to high risk patients for ETV. Pharmacological prophylaxis was very low. ETV risk scales knowlegde is not adequate(AU)

Determinación del riesgo de tromboembolismo pulmonar y trombosis venosa profunda en pacientes hospitalizados en un servicio de medicina interna / Determination of the risk of lung thromboembolism and deep venous thrombosis in patients hospitalized in an internal medicine service

Objetivo General: Determinar el riesgo de Tromboembolismo pulmonar (TEP) y Trombosis venosa profunda (TVP) en un grupo pacientes con patologías médicas. Métodos: Se realizó un estudio, unicéntrico, descriptivo, longitudinal, en pacientes > 18 años, ingresados por un periodo mayor de 72 horas en el servicio de medicina interna del Hospital Central del IVSS "Dr. Miguel Pérez Carreño", aplicando los modelos de evaluación de riesgos de Padua y Caprini. Resultados: La muestra estuvo representada por 114, el promedio de edad fue de 51 años ± 23, de mayoría femenino con 55 %, el principal diagnóstico de ingreso hospitalario, fue de origen infeccioso con 42,2 %. La escala Padua clasificó como bajo riesgo al 88,6 % y Caprini en alto riesgo al 36,8 %. El primer factor de riesgo fue la edad > 40 años con 82,46 %. El 3,51% de los pacientes presentaron un evento tromboembólico, teniendo positividad en el Dímero D con una media de 733,7 ± 181,3, al igual el eco-doppler venoso y en el caso de TEP, el angiotac pulmonar evidenció trombo de la rama derecha de la arteria pulmonar. Los dos factores de riesgo en este grupo estuvo dado por la edad (>65 años) y tasa de filtración glomerular <90 mL/min/1.73m2. El modelo de evaluación de riesgos de Padua presentó mayor capacidad predictiva (p < 0,05). Conclusión: La presencia de ETEV fue baja, a pesar que la muestra evaluada presentaba factores de riesgo y sin terapia trombo profiláctica, que evidencia la necesidad de evaluar los modelos de riesgos en pacientes con patologías médicas hospitalizados

General Objective: To determine the risk of pulmonary thromboembolism (PET) and deep vein thrombosis (DVT) in a group of patients with medical pathologies. Methods: A longitudinal, descriptive, single-center study was conducted in patients > 18 years, admitted for a period of more than 72 hours in the internal medicine service of the Central Hospital of the IVSS "Dr. Miguel Pérez Carreño", applying the Padua and Caprini risk assessment models. Results: The sample was represented by 114, the average age was 51 years ± 23, mostly female with 55 %, the main diagnosis of hospital admission, was of infectious origin with 42,2 %. The Padua scale classified 88,6 % as low risk and Caprini as high risk 36.8 %. The first risk factor was age > 40 years with 82,46 %. 3,51% of the patients presented a thromboembolic event, having a D-Dimer positivity with a mean of 733,7 ± 181,3, like venous echo-Doppler and, in the case of PET, pulmonary angiotac showed thrombus of the right branch of the pulmonary artery. The two risk factors for this group were given by age (> 65 years) and glomerular filtration rate <90 mL / min / 1.73m2. The Padua risk assessment model showed greater predictive capacity (p < 0.05). Conclusion: The presence of VTE was low, despite the fact that the sample evaluated presented risk factors and without thromboprophylactic therapy, which shows the need to evaluate the risk models in patients with hospitalized medical conditions