Tsai James, Grant Althea M, Beckman Michele G, Grosse Scott D, Yusuf Hussain R, Richardson Lisa C
Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS One. 2015 Apr 16;10(4):e0123842. doi: 10.1371/journal.pone.0123842. eCollection 2015.
Venous thromboembolism (VTE) is a significant clinical and public health concern. We evaluated a variety of multilevel factors--demographics, clinical and insurance status, preexisting comorbid conditions, and hospital characteristics--for VTE diagnosis among hospitalizations of US adults.
We generated adjusted odds ratios with 95% confidence intervals (CIs) and determined sources of outcome variation by conducting multilevel logistic regression analysis of data from the 2011 Nationwide Inpatient Sample that included 6,710,066 hospitalizations of US adults nested within 1,039 hospitals.
Among hospitalizations of adults, age, sex, race or ethnicity, total days of hospital stay, status of health insurance, and operating room procedure were important determinants of VTE diagnosis; each of the following preexisting comorbid conditions--acquired immune deficiency syndrome, anemia, arthritis, congestive heart failure, coagulopathy, hypertension, lymphoma, metastatic cancer, other neurological disorders, obesity, paralysis, pulmonary circulation disorders, renal failure, solid tumor without metastasis, and weight loss--was associated independently with 1.04 (95% CI: 1.02-1.06) to 2.91 (95% CI: 2.81-3.00) times increased likelihood of VTE diagnosis than among hospitalizations of adults without any of these corresponding conditions. The presence of 2 or more of such conditions was associated a 180%-450% increased likelihood of a VTE diagnosis. Hospitalizations of adults who were treated in urban hospitals were associated with a 14%-15% increased likelihood of having a VTE diagnosis than those treated in rural hospitals. Approximately 7.4% of the total variation in VTE diagnosis occurred between hospitals.
The presence of certain comorbidities and hospital contextual factors is associated with significantly elevated likelihood of VTE diagnosis among hospitalizations of adults. The findings of this study underscore the importance of clinical risk assessment and adherence to evidence-based clinical practice guidelines in preventing VTE, as well as the need to evaluate potential contextual factors that might modify the risk of VTE among hospitalized patients.
静脉血栓栓塞症（VTE）是一个重大的临床和公共卫生问题。我们评估了美国成年人住院期间VTE诊断的多种多层次因素，包括人口统计学、临床和保险状况、既往合并症以及医院特征。
我们生成了调整后的比值比及其95%置信区间（CI），并通过对2011年全国住院患者样本数据进行多层次逻辑回归分析来确定结果变异的来源，该样本包括嵌套在1039家医院中的6710066例美国成年人住院病例。
在成人住院病例中，年龄、性别、种族或民族、住院总天数、医疗保险状况和手术室手术是VTE诊断的重要决定因素；以下每种既往合并症——获得性免疫缺陷综合征、贫血、关节炎、充血性心力衰竭、凝血病、高血压、淋巴瘤、转移性癌症、其他神经系统疾病、肥胖、瘫痪、肺循环障碍、肾衰竭、无转移实体瘤和体重减轻——与无任何这些相应疾病的成人住院病例相比，VTE诊断可能性独立增加1.04倍（95%CI：1.02 - 1.06）至2.91倍（95%CI：2.81 - 3.00）。存在2种或更多种此类疾病与VTE诊断可能性增加180% - 450%相关。在城市医院接受治疗的成人住院病例与在农村医院接受治疗的病例相比，VTE诊断可能性增加14% - 15%。VTE诊断中约7.4%的总变异发生在医院之间。
某些合并症和医院背景因素的存在与成人住院病例中VTE诊断可能性显著升高相关。本研究结果强调了临床风险评估和遵循循证临床实践指南在预防VTE中的重要性，以及评估可能改变住院患者VTE风险的潜在背景因素的必要性。
