Jones Alan E, Fordham Zachary, Yiannibas Vasilios, Johnson Charles L, Kline Jeffrey A
Department of Emergency Medicine, Emergency Medicine Research, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232-2861, USA.
J Thromb Thrombolysis. 2008 Apr;25(2):160-4. doi: 10.1007/s11239-007-0032-x. Epub 2007 Jun 19.
Prior work suggests that in-hospital pulmonary and venous thromboembolism (VTE) could be decreased if the rate of prophylaxis for VTE in high-risk patients were increased at the time of admission. Our objective was to quantify the rate of thromboprophylaxis and incidence of in-hospital VTE, based upon risk of VTE, in a cohort of patients admitted through the emergency department (ED).
We performed a prospective cohort study at an urban ED with >100,000 visits. All medical patients >17 years admitted from the ED were prospectively identified on a random sample of days for one year. Using a structured data form we collected each patient's risk factors for VTE, and prophylaxis measures. We computed a validated risk score of each patient, with a score >or=4 high-risk (HR) and a score <4 low risk (LR). The main outcome was VTE during the hospitalization, diagnosed after admission from ED.
Of 4732 patients, VTE was diagnosed during hospitalization in 44 (0.9%). 437 (9%) patients were HR for VTE and HR patients had significantly higher frequency of VTE vs. LR patients, 1.8 vs. 0.8% (95% CI for difference of 1% = 0.1-3%). Only 36% of HR patients received thromboprophylaxis. There were no significant differences in the frequency of observed inpatient VTE events between patients who were prescribed prophylaxis compared with those who were not prescribed prophylaxis in either risk group.
These data suggest only a modest opportunity for ED-based policy for thromboprophylaxis in admitted medical patients.
先前的研究表明，如果在入院时提高高危患者静脉血栓栓塞症（VTE）的预防率，住院期间的肺栓塞和VTE可能会减少。我们的目标是根据VTE风险，对通过急诊科（ED）入院的一组患者的血栓预防率和住院期间VTE的发生率进行量化。
我们在一家年就诊量超过10万次的城市急诊科进行了一项前瞻性队列研究。对所有17岁以上从急诊科入院的内科患者，在一年中的随机几天进行前瞻性识别。我们使用结构化数据表格收集每位患者的VTE风险因素和预防措施。我们计算了每位患者经过验证的风险评分，评分≥4为高风险（HR），评分<4为低风险（LR）。主要结局是住院期间的VTE，在从急诊科入院后确诊。
在4732例患者中，44例（0.9%）在住院期间被诊断为VTE。437例（9%）患者为VTE高风险，与低风险患者相比，高风险患者的VTE发生率显著更高，分别为1.8%和0.8%（差异的95%置信区间为1% = 0.1 - 3%）。只有36%的高风险患者接受了血栓预防。在任何一个风险组中，接受预防用药的患者与未接受预防用药的患者相比，观察到的住院VTE事件发生率没有显著差异。
这些数据表明，基于急诊科的内科住院患者血栓预防政策的机会有限。
