Chaudhary Rahul, Kirchoff Robert, Kingsley Thomas, Newman James S, Houghton Damon E, McBane Robert D
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
Division of Vascular Medicine, Mayo Clinic, Rochester, MN.
Mayo Clin Proc Innov Qual Outcomes. 2020 Mar 18;4(2):170-175. doi: 10.1016/j.mayocpiqo.2019.12.004. eCollection 2020 Apr.
To explore the role of venous thromboembolism (VTE) risk reassessment in hospitalized medically ill patients without a change in level of care.
In this exploratory retrospective study, the medical records of 171 consecutive adult patients (≥18 years) hospitalized under the medicine service for more than 3 days without a change in the level of care from January 1, 2015, to March 1, 2015, were reviewed. The primary outcome was a change in the risk score between day 1 and day 3 of hospital stay (using the Padua Prediction Score). The secondary outcomes were changes in risk stratification class (low vs high) and cost-benefit analysis.
The risk score was significantly different between day 1 and day 3 (4.7±1.7 vs 4.2±1.8; =.008). All the patients with low risk on day 1 remained at low risk on day 3. However, 25 of 136 patients (18.4%) with high risk on day 1 were reclassified as low risk on day 3 (<.001). No patients changed from low risk to high risk at day 3. The reclassification could have saved $35 per patient-day of inappropriate pharmacological prophylaxis in addition to patient discomfort, bleeding risk, and heparin-induced thrombocytopenia.
This is the first study to suggest the need for regular assessment for VTE risk on medicine wards because of changing patient risk. Regular reassessment could reduce health care waste and patient discomfort.
探讨静脉血栓栓塞症（VTE）风险重新评估在住院病情无变化的内科患者中的作用。
在这项探索性回顾性研究中，回顾了2015年1月1日至2015年3月1日期间在内科服务下连续住院超过3天且护理级别无变化的171例成年患者（≥18岁）的病历。主要结局是住院第1天和第3天之间风险评分的变化（使用帕多瓦预测评分）。次要结局是风险分层类别（低风险与高风险）的变化以及成本效益分析。
第1天和第3天的风险评分存在显著差异（4.7±1.7对4.2±1.8；P =.008）。第1天低风险的所有患者在第3天仍为低风险。然而，第1天高风险的136例患者中有25例（18.4%）在第3天被重新分类为低风险（P<.001）。第3天没有患者从低风险变为高风险。除了患者不适、出血风险和肝素诱导的血小板减少症外，重新分类可为每位患者每天节省35美元的不适当药物预防费用。
这是第一项表明由于患者风险变化，内科病房需要定期评估VTE风险的研究。定期重新评估可减少医疗保健浪费和患者不适。
