External validation of the simplified Geneva risk assessment model for hospital-associated venous thromboembolism in the Padua cohort.
decision support techniques
hospitalization
pulmonary embolism
risk assessment
venous thrombosis
Journal
Journal of thrombosis and haemostasis : JTH
ISSN: 1538-7836
Titre abrégé: J Thromb Haemost
Pays: England
ID NLM: 101170508
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
06
09
2019
accepted:
21
11
2019
pubmed:
30
11
2019
medline:
15
5
2021
entrez:
30
11
2019
Statut:
ppublish
Résumé
The simplified Geneva risk assessment model (RAM) predicts the risk of hospitalization-related venous thromboembolism (VTE) in medical inpatients in its developmental cohort but has not been validated. To externally validate the simplified Geneva RAM. For this secondary analysis of a prospective cohort set in Padua, we calculated the simplified Geneva RAM for all participants. They were followed up for 90 days for the occurrence of adjudicated VTE. Thirty- and 90-day risks of VTE were estimated by the Kaplan-Meier method, and categories of risks compared with a Cox regression model adjusted for the use of thromboprophylaxis. Among 1180 medical inpatients, the 90-day risk of symptomatic VTE was 3.1%. The simplified Geneva RAM classified 56.9% as high risk (≥3 points; 90-day risk of VTE of 5.2%) and 43.1% as low risk (<3 points; 90-day risk of VTE of 0.4%). Compared with low-risk participants, high-risk participants had an 18-fold greater risk of VTE than low-risk participants (hazard ratio [HR] 17.9, 95% confidence interval [CI] 4.3-74.7). A very high-risk category (≥7 points) identified 5.3% of participants with a 9.5% probability of VTE at 90 days. In this external validation study, we confirm the excellent discrimination and clinically adequate calibration of the simplified Geneva RAM as a stratification tool to guide the use of thromboprophylaxis.
Sections du résumé
BACKGROUND
The simplified Geneva risk assessment model (RAM) predicts the risk of hospitalization-related venous thromboembolism (VTE) in medical inpatients in its developmental cohort but has not been validated.
OBJECTIVES
To externally validate the simplified Geneva RAM.
PATIENTS/METHODS
For this secondary analysis of a prospective cohort set in Padua, we calculated the simplified Geneva RAM for all participants. They were followed up for 90 days for the occurrence of adjudicated VTE. Thirty- and 90-day risks of VTE were estimated by the Kaplan-Meier method, and categories of risks compared with a Cox regression model adjusted for the use of thromboprophylaxis.
RESULTS
Among 1180 medical inpatients, the 90-day risk of symptomatic VTE was 3.1%. The simplified Geneva RAM classified 56.9% as high risk (≥3 points; 90-day risk of VTE of 5.2%) and 43.1% as low risk (<3 points; 90-day risk of VTE of 0.4%). Compared with low-risk participants, high-risk participants had an 18-fold greater risk of VTE than low-risk participants (hazard ratio [HR] 17.9, 95% confidence interval [CI] 4.3-74.7). A very high-risk category (≥7 points) identified 5.3% of participants with a 9.5% probability of VTE at 90 days.
CONCLUSIONS
In this external validation study, we confirm the excellent discrimination and clinically adequate calibration of the simplified Geneva RAM as a stratification tool to guide the use of thromboprophylaxis.
Identifiants
pubmed: 31782886
doi: 10.1111/jth.14688
pii: S1538-7836(22)03794-1
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
676-680Informations de copyright
© 2019 International Society on Thrombosis and Haemostasis.
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