A simplified stratification system for venous thromboembolism risk in severely injured trauma patients

Jonathan P. Meizoso, Charles A. Karcutskie, Juliet J. Ray, Xiomara Ruiz, Enrique Ginzburg, Nicholas Namias, Carl I Schulman, Kenneth G Proctor

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background The objective of this study was to re-evaluate and simplify the Greenfield risk assessment profile (RAP) for venous thromboembolism (VTE) in trauma using information readily available at the bedside. Methods Retrospective review of 1233 consecutive admissions to the trauma intensive care unit from August 2011-January 2015. Univariate analyses were performed to determine which RAP risk factors were significant contributors to VTE. Multivariable logistic regression was used to develop models for risk stratification. All results were considered statistically significant at P ≤ 0.05. Results The study population was as follows: age 44 ± 19, 75% male, 72% blunt, injury severity score 21 ± 13, RAP score 9 ± 5, and 8% mortality. Groups were separated into +VTE (n = 104) and −VTE (n = 1129). They were similar in age, gender, mechanism, and mortality, but injury severity and RAP scores were higher in the +VTE group (all P < 0.0001). The +VTE group had more transfusions and longer time to prophylaxis (all P < 0.05). Receiving four or more transfusions in the first 24 h (odds ratio [OR], 2.60; 95% confidence interval [CI], 1.64-4.13), Glasgow coma score <8 for >4 h (OR, 2.13; 95% CI, 1.28-3.54), pelvic fracture (OR, 2.26; 95% CI, 1.44-3.57), age 40-59 y (OR, 1.70; 95% CI, 1.10-2.63), and >2-h operation (OR, 1.80; 95% CI, 1.14-2.85) predicted VTE with an area under the receiver operator curve of 0.729, which was comparable with 0.740 for the RAP score alone. Conclusions VTE risk in trauma can be easily assessed using only five risk factors, which are all readily available at the bedside (transfusion, Glasgow coma scale, pelvic fracture, prolonged operation, and age). This simplified model provides similar predictive ability to the more complicated RAP score. Prospective validation of a simplified risk assessment score is warranted.

Original languageEnglish (US)
Pages (from-to)138-144
Number of pages7
JournalJournal of Surgical Research
Volume207
DOIs
StatePublished - Jan 1 2017

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Venous Thromboembolism
Wounds and Injuries
Nonpenetrating Wounds
Glasgow Coma Scale
Injury Severity Score
Mortality
Intensive Care Units
Logistic Models
Population

Keywords

  • Deep vein thrombosis
  • Pulmonary embolism
  • Risk assessment
  • Thromboprophylaxis
  • Venous thromboembolism

ASJC Scopus subject areas

  • Surgery

Cite this

A simplified stratification system for venous thromboembolism risk in severely injured trauma patients. / Meizoso, Jonathan P.; Karcutskie, Charles A.; Ray, Juliet J.; Ruiz, Xiomara; Ginzburg, Enrique; Namias, Nicholas; Schulman, Carl I; Proctor, Kenneth G.

In: Journal of Surgical Research, Vol. 207, 01.01.2017, p. 138-144.

Research output: Contribution to journalArticle

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title = "A simplified stratification system for venous thromboembolism risk in severely injured trauma patients",
abstract = "Background The objective of this study was to re-evaluate and simplify the Greenfield risk assessment profile (RAP) for venous thromboembolism (VTE) in trauma using information readily available at the bedside. Methods Retrospective review of 1233 consecutive admissions to the trauma intensive care unit from August 2011-January 2015. Univariate analyses were performed to determine which RAP risk factors were significant contributors to VTE. Multivariable logistic regression was used to develop models for risk stratification. All results were considered statistically significant at P ≤ 0.05. Results The study population was as follows: age 44 ± 19, 75{\%} male, 72{\%} blunt, injury severity score 21 ± 13, RAP score 9 ± 5, and 8{\%} mortality. Groups were separated into +VTE (n = 104) and −VTE (n = 1129). They were similar in age, gender, mechanism, and mortality, but injury severity and RAP scores were higher in the +VTE group (all P < 0.0001). The +VTE group had more transfusions and longer time to prophylaxis (all P < 0.05). Receiving four or more transfusions in the first 24 h (odds ratio [OR], 2.60; 95{\%} confidence interval [CI], 1.64-4.13), Glasgow coma score <8 for >4 h (OR, 2.13; 95{\%} CI, 1.28-3.54), pelvic fracture (OR, 2.26; 95{\%} CI, 1.44-3.57), age 40-59 y (OR, 1.70; 95{\%} CI, 1.10-2.63), and >2-h operation (OR, 1.80; 95{\%} CI, 1.14-2.85) predicted VTE with an area under the receiver operator curve of 0.729, which was comparable with 0.740 for the RAP score alone. Conclusions VTE risk in trauma can be easily assessed using only five risk factors, which are all readily available at the bedside (transfusion, Glasgow coma scale, pelvic fracture, prolonged operation, and age). This simplified model provides similar predictive ability to the more complicated RAP score. Prospective validation of a simplified risk assessment score is warranted.",
keywords = "Deep vein thrombosis, Pulmonary embolism, Risk assessment, Thromboprophylaxis, Venous thromboembolism",
author = "Meizoso, {Jonathan P.} and Karcutskie, {Charles A.} and Ray, {Juliet J.} and Xiomara Ruiz and Enrique Ginzburg and Nicholas Namias and Schulman, {Carl I} and Proctor, {Kenneth G}",
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T1 - A simplified stratification system for venous thromboembolism risk in severely injured trauma patients

AU - Meizoso, Jonathan P.

AU - Karcutskie, Charles A.

AU - Ray, Juliet J.

AU - Ruiz, Xiomara

AU - Ginzburg, Enrique

AU - Namias, Nicholas

AU - Schulman, Carl I

AU - Proctor, Kenneth G

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background The objective of this study was to re-evaluate and simplify the Greenfield risk assessment profile (RAP) for venous thromboembolism (VTE) in trauma using information readily available at the bedside. Methods Retrospective review of 1233 consecutive admissions to the trauma intensive care unit from August 2011-January 2015. Univariate analyses were performed to determine which RAP risk factors were significant contributors to VTE. Multivariable logistic regression was used to develop models for risk stratification. All results were considered statistically significant at P ≤ 0.05. Results The study population was as follows: age 44 ± 19, 75% male, 72% blunt, injury severity score 21 ± 13, RAP score 9 ± 5, and 8% mortality. Groups were separated into +VTE (n = 104) and −VTE (n = 1129). They were similar in age, gender, mechanism, and mortality, but injury severity and RAP scores were higher in the +VTE group (all P < 0.0001). The +VTE group had more transfusions and longer time to prophylaxis (all P < 0.05). Receiving four or more transfusions in the first 24 h (odds ratio [OR], 2.60; 95% confidence interval [CI], 1.64-4.13), Glasgow coma score <8 for >4 h (OR, 2.13; 95% CI, 1.28-3.54), pelvic fracture (OR, 2.26; 95% CI, 1.44-3.57), age 40-59 y (OR, 1.70; 95% CI, 1.10-2.63), and >2-h operation (OR, 1.80; 95% CI, 1.14-2.85) predicted VTE with an area under the receiver operator curve of 0.729, which was comparable with 0.740 for the RAP score alone. Conclusions VTE risk in trauma can be easily assessed using only five risk factors, which are all readily available at the bedside (transfusion, Glasgow coma scale, pelvic fracture, prolonged operation, and age). This simplified model provides similar predictive ability to the more complicated RAP score. Prospective validation of a simplified risk assessment score is warranted.

AB - Background The objective of this study was to re-evaluate and simplify the Greenfield risk assessment profile (RAP) for venous thromboembolism (VTE) in trauma using information readily available at the bedside. Methods Retrospective review of 1233 consecutive admissions to the trauma intensive care unit from August 2011-January 2015. Univariate analyses were performed to determine which RAP risk factors were significant contributors to VTE. Multivariable logistic regression was used to develop models for risk stratification. All results were considered statistically significant at P ≤ 0.05. Results The study population was as follows: age 44 ± 19, 75% male, 72% blunt, injury severity score 21 ± 13, RAP score 9 ± 5, and 8% mortality. Groups were separated into +VTE (n = 104) and −VTE (n = 1129). They were similar in age, gender, mechanism, and mortality, but injury severity and RAP scores were higher in the +VTE group (all P < 0.0001). The +VTE group had more transfusions and longer time to prophylaxis (all P < 0.05). Receiving four or more transfusions in the first 24 h (odds ratio [OR], 2.60; 95% confidence interval [CI], 1.64-4.13), Glasgow coma score <8 for >4 h (OR, 2.13; 95% CI, 1.28-3.54), pelvic fracture (OR, 2.26; 95% CI, 1.44-3.57), age 40-59 y (OR, 1.70; 95% CI, 1.10-2.63), and >2-h operation (OR, 1.80; 95% CI, 1.14-2.85) predicted VTE with an area under the receiver operator curve of 0.729, which was comparable with 0.740 for the RAP score alone. Conclusions VTE risk in trauma can be easily assessed using only five risk factors, which are all readily available at the bedside (transfusion, Glasgow coma scale, pelvic fracture, prolonged operation, and age). This simplified model provides similar predictive ability to the more complicated RAP score. Prospective validation of a simplified risk assessment score is warranted.

KW - Deep vein thrombosis

KW - Pulmonary embolism

KW - Risk assessment

KW - Thromboprophylaxis

KW - Venous thromboembolism

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