Bikdeli Behnood, Sharif-Kashani Babak, Raeissi Sasan, Ehteshami-Afshar Solmaz, Behzadnia Neda, Masjedi Mohammad-Reza
Cardiovascular Department, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University MC, Tehran, Iran.
Blood Coagul Fibrinolysis. 2011 Dec;22(8):667-72. doi: 10.1097/MBC.0b013e32834ad76d.
Venous thromboembolism (VTE) is a major cause of in-hospital mortality. Several international guidelines provide thromboprophylaxis recommendations; however, guidelines adherence is missing worldwide. We evaluated the chest physicians' knowledge regarding VTE prophylaxis, using a systematically developed questionnaire. The Prophylaxis-foR-venOus-throMbOembolism-assessmenT-questionnairE (PROMOTE) questionnaire was developed using an algorithm encompassing the most important VTE prophylaxis topics and included 13 clinical scenarios. Responses were evaluated with reference to the eighth edition of American College of Chest Physicians guidelines for VTE prevention to assess thromboprophylaxis appropriateness. The questionnaires were distributed during the fourth International Congress on Pulmonary Disease, Intensive Care and Tuberculosis. From the 88 received questionnaires (response rate: 39.8%), 82 were acceptable (62 men, 20 women). The most commonly cited VTE risk factors were immobility (79.2%), surgery (68.2%), and cancer (60.9%). The mean correct response ratio to the questions was 67% [95% confidence interval (CI) 64-70%] with highest appropriateness ratios amongst cardiologists (77.1 ± 5.8%) and lowest ratios among thoracic surgeons (59.2 ± 5%). Physicians' specialty had a significant effect on the overall appropriateness (P = 0.04) and most of appropriateness subcategories. Thoracic surgeons had the lowest rate of over-prophylaxis (P = 0.02). Years passed from graduation were inversely associated with overall appropriateness (P = 0.006). Physicians with academic engagements had a higher overall appropriateness (P = 0.04). We found a wide gap between the guideline recommendations and the responses. PROMOTE is the first systematically developed questionnaire that addresses chest physicians' thromboprophylaxis knowledge and could be useful to strategies to improve VTE prophylaxis. Because of the dissimilar prophylaxis pitfalls of different specialists, distinct educational programs seem necessary to improve their knowledge of proper VTE prophylaxis.
静脉血栓栓塞症（VTE）是住院患者死亡的主要原因。多项国际指南提供了血栓预防建议；然而，全球范围内都存在指南依从性不足的问题。我们使用系统开发的问卷评估了胸科医生关于VTE预防的知识。静脉血栓栓塞症预防评估问卷（PROMOTE）是使用包含最重要的VTE预防主题的算法开发的，包含13个临床场景。根据美国胸科医师学会VTE预防指南第八版对回答进行评估，以评估血栓预防的适当性。问卷在第四届国际肺病、重症监护和结核病大会期间分发。在收到的88份问卷中（回复率：39.8%），82份可接受（62名男性，20名女性）。最常被提及的VTE危险因素是活动受限（79.2%）、手术（68.2%）和癌症（60.9%）。问题的平均正确回答率为67%[95%置信区间（CI）64 - 70%]，心脏病专家的适当率最高（77.1±5.8%），胸外科医生的适当率最低（59.2±5%）。医生的专业对总体适当性（P = 0.04）和大多数适当性子类别有显著影响。胸外科医生过度预防的发生率最低（P = 0.02）。毕业年限与总体适当性呈负相关（P = 0.006）。有学术活动的医生总体适当性更高（P = 0.04）。我们发现指南建议与回答之间存在很大差距。PROMOTE是首个系统开发的针对胸科医生血栓预防知识的问卷，可能有助于改善VTE预防的策略。由于不同专科医生预防的陷阱不同，似乎需要不同的教育项目来提高他们对正确VTE预防的认识。
