Veith Jacob, Collier Willem, Rockwell W Bradford, Pannucci Christopher
Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
Plast Reconstr Surg Glob Open. 2019 Aug 8;7(8):e2363. doi: 10.1097/GOX.0000000000002363. eCollection 2019 Aug.
We examined the ability of plastic surgery patients to perform their own venous thromboembolism (VTE) risk stratification using a previously validated patient-completed Caprini risk scoring sheet.
Patients' Caprini scores were obtained by an attending physician at an office visit through interview and chart review. Subsequently, patients independently completed a previously validated patient reported scoring sheet. We compared patient and physician reported Caprini scores by each Caprini subquestion and by the overall score. We described discordance of scores using frequencies and proportions, quantified the level of agreement using Cohen's Kappa coefficient, Spearman's correlation coefficient, and the Wilcoxon rank-sum test, and visualize scoring differences using Bland-Altman plots, where appropriate.
We prospectively enrolled 50 patients. Only 24% (n = 12) of patients had exact matches in physician-completed and patient-completed Caprini scores. Among the 76% (n = 38) with discrepancies, 26 received a higher patient-reported score (median = 2 points, range 1-8 points) and 12 received a lower patient-reported score (median = -1.5 points, range -1 to -6 points). Existing venous thromboembolism prophylaxis guidelines support chemical prophylaxis for inpatients with Caprini scores ≥7. Among 38 patients with score discrepancies, 8 (21.1%) would have been incorrectly prescribed chemical prophylaxis and 4 (10.5%) would have been incorrectly denied chemical prophylaxis.
Plastic surgery patients cannot reliably calculate their own 2005 Caprini scores. Reliance on patient completed scores alone would promote ~25% of patients receiving inappropriate prophylaxis strategies.
我们使用先前验证过的患者填写的卡普里尼风险评分表，研究了整形手术患者进行自身静脉血栓栓塞（VTE）风险分层的能力。
主治医生在门诊就诊时通过访谈和病历审查获取患者的卡普里尼评分。随后，患者独立完成一份先前验证过的患者报告评分表。我们按每个卡普里尼子问题和总分比较患者与医生报告的卡普里尼评分。我们使用频率和比例描述评分不一致情况，使用科恩卡方系数、斯皮尔曼相关系数和威尔科克森秩和检验量化一致性水平，并在适当情况下使用布兰德 - 奥特曼图直观显示评分差异。
我们前瞻性纳入了50例患者。只有24%（n = 12）的患者在医生填写和患者填写的卡普里尼评分中完全匹配。在有差异的76%（n = 38）患者中，26例患者报告的评分较高（中位数 = 2分，范围1 - 8分），12例患者报告的评分较低（中位数 = -1.5分，范围 -1至 -6分）。现有的静脉血栓栓塞预防指南支持对卡普里尼评分≥7的住院患者进行药物预防。在38例评分有差异的患者中，8例（21.1%）会被错误地开具药物预防处方，4例（10.5%）会被错误地拒绝药物预防。
整形手术患者无法可靠地计算自己的2005年卡普里尼评分。仅依赖患者填写的评分会导致约25%的患者接受不适当预防策略。
