ABSTRACT
Venous thromboembolism (VTE) is a major contributor to hospital mortality and disability-adjusted life-year (DALY) loss. Multiple guidelines recommend using the Padua or IMPROVE scores to stratify VTE risk in hospitalized medical patients. However, the IMPROVE score is not recommended in Chinese guidelines, and there is very little evaluation of its clinical application and effectiveness in the Chinese population. The objective of this study is to compare the efficacy of the Padua and IMPROVE scoring models for assessing VTE risk in Chinese medical inpatients. We conducted a retrospective analysis of the clinical characteristics and thrombotic risk of 42,257 medical inpatients at a tertiary hospital in Guangdong, China, between 2021 and 2022. Logistic regression was used to assess thrombotic risk factors. The Receiver Operating Characteristic (ROC) curves, Area Under the Curve (AUC), sensitivity, and specificity were employed to evaluate the performance of the two models. Of the 42,257 patients included, 948 (2.24%) experienced VTE during hospitalization. According to the Padua score, 3,7513 (88.78%) of patients were considered low risk, while 4,744 (18.22%) were classified as high risk. The IMPROVE score identified 20,744 (49.09%) of patients as low risk, 20799(49.22%) as intermediate risk, and 714(1.69%) as high risk. The AUC for the Padua score was 0.735 (95% CI: 0.717-0.753), with a sensitivity of 49.4% and specificity of 89.6%. For the IMPROVE score, the AUC was 0.711 (95% CI: 0.693-0.729), with a sensitivity of 32.5% and specificity of 99.0%. The DeLong test, used to compare the AUCs, yielded a z-value of 1.886 with a P-value of 0.059, indicating no statistical difference. When assessing VTE risk in patients with stroke, cancer, nephrotic syndrome, and critical illness (ICU/CCU stay), both scoring models showed comparable predictive performance with AUCs ranging between 0.7 and 0.8. Both the Padua score and IMPROVE score have good predictive ability for VTE events during hospitalization in medical patients. Among them, the IMPROVE score has objective assessment items, simpler operation, and more detailed risk stratification, which is beneficial for clinicians to take physical and pharmacological preventive measures at different levels.ChiCTR2200056903, February 22, retrospectively registered.
Subject(s)
Inpatients , Venous Thromboembolism , Humans , Venous Thromboembolism/epidemiology , Venous Thromboembolism/diagnosis , Venous Thromboembolism/etiology , China/epidemiology , Female , Male , Risk Assessment/methods , Middle Aged , Retrospective Studies , Aged , Risk Factors , Hospitalization , Adult , ROC CurveABSTRACT
Objective:A comparison was made between the predictive efficacy of the Padua Score and the simplified Assessment Scheme Recommended by Chinese experts (hereinafter referred to as the Simplified Method) for the risk assessment of venous thromboembolism (VTE) in medical inpatients, aiming to provide a reference for the clinical selection of appropriate risk assessment tools.Methods:A retrospective cohort study was conducted, selecting 42 257 internal medicine inpatients discharged from Peking University Shenzhen Hospital between May 1, 2021, and April 30, 2022, using a convenience sampling method. Data collected included general information upon admission, VTE-related information, occurrences of VTE during hospitalization, and results from the two assessment tools. The predictive efficacy of the tools was evaluated by plotting ROC curves and calculating AUC, sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy.Results:Among 42 257 patients, there were 21 065 male and 21 192 female participants, aged (55.04 ± 15.17) years old. The incidence rate of VTE among medical inpatients was 2.24% (948/42 257). The AUC for Padua Score and the Simplified Method in medical patients were 0.735 (95% CI 0.717-0.753) and 0.582 (95% CI 0.561-0.602), respectively. Sensitivities were 49.4% and 18.2%, specificities were 89.6% and 98.1%, positive predictive values were 9.9% and 17.7%, negative predictive values were 98.7% and 98.1%, and predictive accuracy were 88.7% and 96.3%, respectively. The departments with the highest incidence rates of VTE during hospitalization were rehabilitation medicine, emergency, neurology, geriatrics, and respiratory medicine. Within these departments, the AUC values for the Padua Score and the Simplified Method were as follows: 0.864 and 0.612, 0.782 and 0.653, 0.792 and 0.664, 0.850 and 0.551, 0.867 and 0.664, respectively. Conclusions:The Padua Score demonstrated better predictive efficacy compared to the Simplified Method. However, the Simplified Method had more accessible assessment criteria and could serve as an initial VTE risk screening tool in emergency situations or when complete data are not available.
ABSTRACT
Objective:To investigate the assessment and occurrence of first-occured venous thromboembolism(VTE) among hospitalized patients.Methods:The clinical data of 6 532 surgical patients in Shenzhen Hospital, Peking University who were admitted from May 1, 2021 to June 30, 2021 were collected and analyzed retrospectively. The demographic data, Caprini score at admission and the incidence of VTE during hospitalization were analyzed by two independent sample t test and chi square test. Results:The Caprini score at admission of 6 532 patients was 1.81 ± 1.71. The number of cases in high, medium and low risks was 363 (5.6%), 1 189 (18.2%), 4 980 (76.2%), respectively. There was significant difference in VTE risk assessment scores and grades in different gender ( t=5.31, χ 2=48.31), length of stay ( F=195.21, χ 2=548.52) and hypertension ( t=17.07, χ 2=280.89), diabetes ( t=12.14, χ 2=51.18), smoking ( F=31.71, χ 2=53.23) and drinking ( F=18.78, χ 2=30.07) ( P<0.05). Forty-four(0.7%) patients got hospital-acquired VTE totally, among which, 24 cases (6.6%) were in high-risk, 14 cases (1.2%) were in medium-risk and 6 cases (0.1%) were in low-risk. What′s more, the top five VTE risky departments based on the assessment were not completely consistent with the top five departments with the highest incidence of VTE. Conclusions:The hospitalized patients are at high risk of VTE. The risk factors of diabetes, hypertension, smoking, drinking and other related factors should be included in the evaluation model. Meanwhile, the VTE risk assessment of in-patients should be emphasized and prophylactic treatments should be taken to reduce the incidence of VTE.
ABSTRACT
Objective:To explore the perioperative safety management of patients with severe limb dysplasia, to select appropriate methods to monitor vital signs, and to prevent intraoperative acquired pressure sore, nosocomial infection and other related complications.Methods:A case of severe developmental disorder of extremities caused by acroscleroderma in November 2019 in Peking University Shenzhen Hospital needed to be amputated. By organizing multidisciplinary consultation to discuss the operation plan, repeatedly selecting appropriate tools, and multiple scenario simulation exercises, continuous transcutaneous oxygen saturation and noninvasive blood pressure monitoring could be realized for the patients with acromegaly deficiency of the extremities. Under the monitoring of color ultrasound, the arterial blocking pressure of the extremities was determined as the tourniquet pressure during the operation value, take appropriate measures to prevent intraoperative acquired pressure sore, nosocomial infection and other related complications.Results:With the cooperation of multidisciplinary team, amputation was successfully carried out for the patients. The position was comfortable during the operation, the operation process was smooth, the residual limbs healed well after the operation, and there was no intraoperative acquired pressure sore, nosocomial infection and other related complications.Conclusions:To establish a multidisciplinary cooperation mechanism, strengthen the construction of the operating room special group, and use evidence-based nursing methods and actual scenario simulation exercise can ensure the perioperative safety of patients with severe developmental disorder of extremities and similar patients with special body shape or very low weight.
ABSTRACT
Objective:To develop a negative emotion screening scale for inpatients(NESSI) and test its validity and reliability.Methods:Based on our previous studies and the theory model of psychological stress, the original item pool was established through literature review, expert interviews and patient consultation.The first version of NESSI was constructed by Delphi method, then initially tested in 421 inpatients followed by the project analysis and reliability test. After those above, the formal scale was developed and tested in 318 inpatients followed by confirmatory factor analysis and reliability test.Finally, 7-item generalized anxiety disorder scale (GAD-7), 9-item patient health questionnaire (PHQ-9), anger state expression scale (SAS) and simplified Chinese version of fear of disease progression scale(FoP-Q-SF) were used to test the criterion validity.Results:After exploratory factor analysis, 17 items were retained in the final scale, which can be categorized into four dimensions: fear of illness, depression, somatization and anger, which could explain 63.49% of the total variation.Confirmatory factor analysis showed that the fitting degree of each factor model was good and met the requirements of reference value (χ 2/ df=2.949, RMR=0.044, CFI=0.929, NFI=0.897, IFI=0.930, TLI=0.915, PGFI=0.655, RMSEA=0.078). The Cronbach's α coefficient of the total scale was 0.925, and the Cronbach's α coefficient of the four factors ranged from 0.762 to 0.898.The criterion validity showed that there was a significant positive correlation between the scale and the four criterion scales ( r= 0.574-0.805, all P<0.01). Conclusion:The NESSI scale has good reliability and validity, and can be used as a psychological problem screening tool among non-psychiatric inpatients.