Validation of Risk Assessment Models of Venous Thromboembolism in Hospitalized Medical Patients
Patients hospitalized for acute medical illness are at increased risk for venous thromboembolism. Although risk assessment is recommended and several at-admission risk assessment models have been developed, these have not been adequately derived or externally validated. Therefore, an optimal approac...
Uloženo v:
| Vydáno v: | The American journal of medicine Ročník 129; číslo 9; s. 1001.e9 |
|---|---|
| Hlavní autoři: | , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
United States
01.09.2016
|
| Témata: | |
| ISSN: | 1555-7162, 1555-7162 |
| On-line přístup: | Zjistit podrobnosti o přístupu |
| Tagy: |
Přidat tag
Žádné tagy, Buďte první, kdo vytvoří štítek k tomuto záznamu!
|
| Abstract | Patients hospitalized for acute medical illness are at increased risk for venous thromboembolism. Although risk assessment is recommended and several at-admission risk assessment models have been developed, these have not been adequately derived or externally validated. Therefore, an optimal approach to evaluate venous thromboembolism risk in medical patients is not known.
We conducted an external validation study of existing venous thromboembolism risk assessment models using data collected on 63,548 hospitalized medical patients as part of the Michigan Hospital Medicine Safety (HMS) Consortium. For each patient, cumulative venous thromboembolism risk scores and risk categories were calculated. Cox regression models were used to quantify the association between venous thromboembolism events and assigned risk categories. Model discrimination was assessed using Harrell's C-index.
Venous thromboembolism incidence in hospitalized medical patients is low (1%). Although existing risk assessment models demonstrate good calibration (hazard ratios for "at-risk" range 2.97-3.59), model discrimination is generally poor for all risk assessment models (C-index range 0.58-0.64).
The performance of several existing risk assessment models for predicting venous thromboembolism among acutely ill, hospitalized medical patients at admission is limited. Given the low venous thromboembolism incidence in this nonsurgical patient population, careful consideration of how best to utilize existing venous thromboembolism risk assessment models is necessary, and further development and validation of novel venous thromboembolism risk assessment models for this patient population may be warranted. |
|---|---|
| AbstractList | Patients hospitalized for acute medical illness are at increased risk for venous thromboembolism. Although risk assessment is recommended and several at-admission risk assessment models have been developed, these have not been adequately derived or externally validated. Therefore, an optimal approach to evaluate venous thromboembolism risk in medical patients is not known.
We conducted an external validation study of existing venous thromboembolism risk assessment models using data collected on 63,548 hospitalized medical patients as part of the Michigan Hospital Medicine Safety (HMS) Consortium. For each patient, cumulative venous thromboembolism risk scores and risk categories were calculated. Cox regression models were used to quantify the association between venous thromboembolism events and assigned risk categories. Model discrimination was assessed using Harrell's C-index.
Venous thromboembolism incidence in hospitalized medical patients is low (1%). Although existing risk assessment models demonstrate good calibration (hazard ratios for "at-risk" range 2.97-3.59), model discrimination is generally poor for all risk assessment models (C-index range 0.58-0.64).
The performance of several existing risk assessment models for predicting venous thromboembolism among acutely ill, hospitalized medical patients at admission is limited. Given the low venous thromboembolism incidence in this nonsurgical patient population, careful consideration of how best to utilize existing venous thromboembolism risk assessment models is necessary, and further development and validation of novel venous thromboembolism risk assessment models for this patient population may be warranted. Patients hospitalized for acute medical illness are at increased risk for venous thromboembolism. Although risk assessment is recommended and several at-admission risk assessment models have been developed, these have not been adequately derived or externally validated. Therefore, an optimal approach to evaluate venous thromboembolism risk in medical patients is not known.BACKGROUNDPatients hospitalized for acute medical illness are at increased risk for venous thromboembolism. Although risk assessment is recommended and several at-admission risk assessment models have been developed, these have not been adequately derived or externally validated. Therefore, an optimal approach to evaluate venous thromboembolism risk in medical patients is not known.We conducted an external validation study of existing venous thromboembolism risk assessment models using data collected on 63,548 hospitalized medical patients as part of the Michigan Hospital Medicine Safety (HMS) Consortium. For each patient, cumulative venous thromboembolism risk scores and risk categories were calculated. Cox regression models were used to quantify the association between venous thromboembolism events and assigned risk categories. Model discrimination was assessed using Harrell's C-index.METHODSWe conducted an external validation study of existing venous thromboembolism risk assessment models using data collected on 63,548 hospitalized medical patients as part of the Michigan Hospital Medicine Safety (HMS) Consortium. For each patient, cumulative venous thromboembolism risk scores and risk categories were calculated. Cox regression models were used to quantify the association between venous thromboembolism events and assigned risk categories. Model discrimination was assessed using Harrell's C-index.Venous thromboembolism incidence in hospitalized medical patients is low (1%). Although existing risk assessment models demonstrate good calibration (hazard ratios for "at-risk" range 2.97-3.59), model discrimination is generally poor for all risk assessment models (C-index range 0.58-0.64).RESULTSVenous thromboembolism incidence in hospitalized medical patients is low (1%). Although existing risk assessment models demonstrate good calibration (hazard ratios for "at-risk" range 2.97-3.59), model discrimination is generally poor for all risk assessment models (C-index range 0.58-0.64).The performance of several existing risk assessment models for predicting venous thromboembolism among acutely ill, hospitalized medical patients at admission is limited. Given the low venous thromboembolism incidence in this nonsurgical patient population, careful consideration of how best to utilize existing venous thromboembolism risk assessment models is necessary, and further development and validation of novel venous thromboembolism risk assessment models for this patient population may be warranted.CONCLUSIONSThe performance of several existing risk assessment models for predicting venous thromboembolism among acutely ill, hospitalized medical patients at admission is limited. Given the low venous thromboembolism incidence in this nonsurgical patient population, careful consideration of how best to utilize existing venous thromboembolism risk assessment models is necessary, and further development and validation of novel venous thromboembolism risk assessment models for this patient population may be warranted. |
| Author | Flanders, Scott A Greene, M Todd Grant, Paul J Chopra, Vineet Bernstein, Steven J Spyropoulos, Alex C Kaatz, Scott |
| Author_xml | – sequence: 1 givenname: M Todd surname: Greene fullname: Greene, M Todd email: mtgreene@med.umich.edu organization: The Michigan Hospital Medicine Safety Consortium Data Coordinating Center, Ann Arbor; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor. Electronic address: mtgreene@med.umich.edu – sequence: 2 givenname: Alex C surname: Spyropoulos fullname: Spyropoulos, Alex C organization: Hofstra North Shore-LIJ School of Medicine, Manhasset, NY – sequence: 3 givenname: Vineet surname: Chopra fullname: Chopra, Vineet organization: The Michigan Hospital Medicine Safety Consortium Data Coordinating Center, Ann Arbor; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; VA Ann Arbor Health Care System, Mich – sequence: 4 givenname: Paul J surname: Grant fullname: Grant, Paul J organization: The Michigan Hospital Medicine Safety Consortium Data Coordinating Center, Ann Arbor; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor – sequence: 5 givenname: Scott surname: Kaatz fullname: Kaatz, Scott organization: Hurley Medical Center, Flint, Mich – sequence: 6 givenname: Steven J surname: Bernstein fullname: Bernstein, Steven J organization: The Michigan Hospital Medicine Safety Consortium Data Coordinating Center, Ann Arbor; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; VA Ann Arbor Health Care System, Mich – sequence: 7 givenname: Scott A surname: Flanders fullname: Flanders, Scott A organization: The Michigan Hospital Medicine Safety Consortium Data Coordinating Center, Ann Arbor; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27107925$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNkN9LwzAQx4NM3A_9D0Ty6EtrkqZp8ziGOsGhyNxryZorZqbN7HUP-tcbcYLHHXfHfflwfKdk1IUOCLnkLOWMq5tdatpdCzYVcUtZFpOfkAnP8zwpuBKjf_OYTBF3LIbO1RkZi4KzQot8QqqN8c6awYWOhoa-OHync0RAbKEb6CpY8Phz2UAXDkjXb31otwFieYctdR1dBty7IWK-wNIVWFcbT58jMgLwnJw2xiNcHPuMvN7drhfL5PHp_mExf0zqXMoh4VxZljUCwBS1hNICiFo3xmqWgdIN1NtGlllZZI02WuesKKQAXgPXykppxIxc_3L3ffg4AA5V67AG700H8e-Kl1zyTDGpovTqKD1so3_Vvnet6T-rP1PENzNEaMs |
| CitedBy_id | crossref_primary_10_1016_j_chest_2020_05_559 crossref_primary_10_1016_j_rpth_2024_102480 crossref_primary_10_2147_VHRM_S392327 crossref_primary_10_1002_rth2_12343 crossref_primary_10_1016_j_amjmed_2020_06_010 crossref_primary_10_1016_j_jcjq_2019_07_011 crossref_primary_10_1186_s12890_024_03323_z crossref_primary_10_1097_CM9_0000000000003025 crossref_primary_10_3390_jcm10225270 crossref_primary_10_1016_j_thromres_2024_109145 crossref_primary_10_1160_TH17_03_0168 crossref_primary_10_7326_AITC202209200 crossref_primary_10_1016_j_ejim_2023_11_017 crossref_primary_10_1111_jep_13213 crossref_primary_10_1016_j_jcrc_2021_02_004 crossref_primary_10_1007_s11912_023_01358_9 crossref_primary_10_1111_jth_14220 crossref_primary_10_1182_bloodadvances_2018022954 crossref_primary_10_1002_rth2_12119 crossref_primary_10_1055_a_1698_6506 crossref_primary_10_1016_j_jtha_2024_06_025 crossref_primary_10_1016_j_rpth_2023_102258 crossref_primary_10_1093_ajhp_zxab039 crossref_primary_10_1161_CIRCOUTCOMES_123_010359 crossref_primary_10_1016_j_chest_2024_07_182 crossref_primary_10_1177_20503121221079488 crossref_primary_10_1016_j_thromres_2020_11_013 crossref_primary_10_1111_jth_14796 crossref_primary_10_2147_COPD_S380418 crossref_primary_10_1182_bloodadvances_2020002482 crossref_primary_10_1080_21548331_2018_1410053 crossref_primary_10_1001_jamanetworkopen_2024_9980 crossref_primary_10_1016_j_mayocp_2020_08_030 crossref_primary_10_1111_bjh_16411 crossref_primary_10_3390_jcm13072133 crossref_primary_10_1097_MD_0000000000027367 crossref_primary_10_1177_0268355519828863 crossref_primary_10_7326_M18_2937 crossref_primary_10_3390_jcm10194294 crossref_primary_10_1111_jth_14929 crossref_primary_10_1002_rth2_12292 crossref_primary_10_7326_M20_0347 crossref_primary_10_1017_ice_2017_167 crossref_primary_10_1016_j_thromres_2023_05_011 crossref_primary_10_1017_ice_2021_141 crossref_primary_10_1080_00325481_2021_1876387 crossref_primary_10_3390_diagnostics14111159 crossref_primary_10_1177_1076029621991185 crossref_primary_10_1177_1076029621995563 crossref_primary_10_1016_j_thromres_2020_06_005 crossref_primary_10_1160_TH16_09_0732 crossref_primary_10_1186_s12959_023_00450_1 crossref_primary_10_1016_j_amjmed_2018_01_017 crossref_primary_10_1111_jth_13687 crossref_primary_10_1002_rth2_12181 crossref_primary_10_1007_s11239_017_1501_5 crossref_primary_10_1097_CCM_0000000000003423 crossref_primary_10_1001_jamanetworkopen_2022_40373 crossref_primary_10_1016_j_ccm_2018_04_002 crossref_primary_10_1016_j_amjmed_2019_12_001 crossref_primary_10_1016_j_thromres_2018_05_028 crossref_primary_10_3389_fmed_2025_1468190 crossref_primary_10_1111_jth_14410 crossref_primary_10_1136_bmjqs_2017_007342 crossref_primary_10_12788_jhm_2847 |
| ContentType | Journal Article |
| Copyright | Published by Elsevier Inc. |
| Copyright_xml | – notice: Published by Elsevier Inc. |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1016/j.amjmed.2016.03.031 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE MEDLINE - Academic |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 1555-7162 |
| ExternalDocumentID | 27107925 |
| Genre | Research Support, Non-U.S. Gov't Journal Article |
| GroupedDBID | --- --K -~X .-4 .1- .55 .FO .GJ 0R~ 123 1B1 1CY 1P~ 1RT 1~5 23M 3O- 4.4 457 4CK 4G. 53G 5RE 5VS 6J9 7-5 AACTN AAEDT AAEDW AALRI AAQFI AAQQT AAQXK AAWTL AAXUO AAYOK ABLJU ABMAC ABOCM ABPPZ ABWVN ACGFO ACIUM ACKOT ACPRK ACRPL ADBBV ADMUD ADNMO ADPAM ADVLN AENEX AEVXI AFCTW AFFNX AFHKK AFJKZ AFRHN AFTJW AGHFR AHHHB AHMBA AITUG AJUYK AKRWK ALMA_UNASSIGNED_HOLDINGS AMRAJ ASPBG AVWKF AZFZN BELOY BKOMP C5W CGR CS3 CUY CVF EBS ECM EFJIC EIF EJD EX3 F5P FDB FEDTE FGOYB FIRID G-2 G-Q GBLVA HEA HMK HMO HVGLF HZ~ IH2 IHE J1W J5H K-O KOM L7B LZ2 M29 M41 MO0 MVM N4W N9A NCXOZ NPM NQ- O9- OD. OHT OO~ P2P PC. PKN PQQKQ R2- RIG ROL RPZ SAE SEL SES SSZ TWZ UBY UHB UHU UNMZH UV1 WH7 WOW WUQ X7M XH2 XPP YFH YOC YQJ YYQ Z5R ZGI ZUP ZXP 7X8 AAFWJ AAYWO ACVFH ADCNI EFKBS |
| ID | FETCH-LOGICAL-c544t-116d03f2eea7c4e8dee2c9fad903e69fecbf483873f9a99507742e1ce196d44a2 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 75 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000382309900048&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 1555-7162 |
| IngestDate | Sat Sep 27 22:18:49 EDT 2025 Wed Feb 19 02:41:44 EST 2025 |
| IsDoiOpenAccess | false |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 9 |
| Keywords | Venous thromboembolism |
| Language | English |
| License | Published by Elsevier Inc. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c544t-116d03f2eea7c4e8dee2c9fad903e69fecbf483873f9a99507742e1ce196d44a2 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| OpenAccessLink | http://hdl.handle.net/10072/394516 |
| PMID | 27107925 |
| PQID | 1814136046 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_1814136046 pubmed_primary_27107925 |
| PublicationCentury | 2000 |
| PublicationDate | 2016-09-01 |
| PublicationDateYYYYMMDD | 2016-09-01 |
| PublicationDate_xml | – month: 09 year: 2016 text: 2016-09-01 day: 01 |
| PublicationDecade | 2010 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | The American journal of medicine |
| PublicationTitleAlternate | Am J Med |
| PublicationYear | 2016 |
| SSID | ssj0000956 |
| Score | 2.4892395 |
| Snippet | Patients hospitalized for acute medical illness are at increased risk for venous thromboembolism. Although risk assessment is recommended and several... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 1001.e9 |
| SubjectTerms | Aged Female Hospitalization - statistics & numerical data Humans Length of Stay - statistics & numerical data Male Michigan - epidemiology Models, Statistical Proportional Hazards Models Reproducibility of Results Risk Assessment Risk Factors Venous Thromboembolism - epidemiology Venous Thromboembolism - etiology |
| Title | Validation of Risk Assessment Models of Venous Thromboembolism in Hospitalized Medical Patients |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/27107925 https://www.proquest.com/docview/1814136046 |
| Volume | 129 |
| WOSCitedRecordID | wos000382309900048&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV07T8MwELaAIsTC-1FeMhJrROo4D0-oQlQMtKpQqbpFsX0WgTYpTcXAr-ecB10YkBjiJYqU2Oe773yX7yPkJgTMq1x7vMRc4_BQSydhOGglWIIAgHFVUuY_hYNBNJmIYX3gVtRtlY1PLB21zpU9I7_FSIT-NsB07m7-4VjVKFtdrSU01knLQyhjrTqcrNjCLcleyZfq-45lSmp-nSv7u5LZG8Yb29wVlDSntczcryCzDDa93f--5h7ZqWEm7VZ2sU_WIDsgW_26kH5I4jHi70pOieaGPqfFO-3-kHRSq5A2LeydccnhSkevi3wmc8BrmhYzmma0URxJv0DTut5DhxVNa3FEXnoPo_tHp9ZacJTP-dLpdALteoYBJKHiEGkApoRJtHA9CIQBJQ2PvCj0jEiEQBSJOTV0FOAO1pwn7JhsZHkGp4RqzaR2fV-GXHLJEJBEnqtkIJTLjQTdJtfN1MVoy7ZAkWSA3xKvJq9NTqr5j-cV6UbMEAqFgvlnf3j6nGzbZa1awS5Iy-BOhkuyqT6XabG4Ko0Ex8Gw_w1Ks8f3 |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Validation+of+Risk+Assessment+Models+of+Venous+Thromboembolism+in+Hospitalized+Medical+Patients&rft.jtitle=The+American+journal+of+medicine&rft.au=Greene%2C+M+Todd&rft.au=Spyropoulos%2C+Alex+C&rft.au=Chopra%2C+Vineet&rft.au=Grant%2C+Paul+J&rft.date=2016-09-01&rft.issn=1555-7162&rft.eissn=1555-7162&rft.volume=129&rft.issue=9&rft.spage=1001.e9&rft_id=info:doi/10.1016%2Fj.amjmed.2016.03.031&rft.externalDBID=NO_FULL_TEXT |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1555-7162&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1555-7162&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1555-7162&client=summon |