{"id":25998,"date":"2024-07-04T04:10:00","date_gmt":"2024-07-03T20:10:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=25998"},"modified":"2024-07-04T04:29:23","modified_gmt":"2024-07-03T20:29:23","slug":"jama-netw-open%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%86%85%e7%a7%91%e4%bd%8f%e9%99%a2%e6%82%a3%e8%80%85%e9%9d%99%e8%84%89%e8%a1%80%e6%a0%93%e6%a0%93%e5%a1%9e%e7%9a%84%e9%a3%8e%e9%99%a9","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=25998","title":{"rendered":"[JAMA Netw Open\u53d1\u8868\u8bba\u6587]\uff1a\u5185\u79d1\u4f4f\u9662\u60a3\u8005\u9759\u8109\u8840\u6813\u6813\u585e\u7684\u98ce\u9669\u8bc4\u4f30\u6a21\u578b"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Cardiology<\/p>\n\n\n\n

May 10, 2024<\/p>\n\n\n\n

Risk Assessment Models for Venous Thromboembolism in Medical Inpatients<\/h1>\n\n\n\n

Emmanuel H\u00e4fliger, Basil Kopp; Pauline Darbellay Farhoumand, et al<\/h3>\n\n\n\n

JAMA Netw Open. <\/em>2024;7(5):e249980. doi:10.1001\/jamanetworkopen.2024.9980<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  What is the prognostic performance of the simplified Geneva score and other validated risk assessment models (RAMs) to predict venous thromboembolism (VTE) in medical inpatients?<\/p>\n\n\n\n

Findings<\/strong>  In this cohort study providing a head-to-head comparison of validated RAMs among 1352 medical inpatients, sensitivity of RAMs to predict 90-day VTE ranged from 39.3% to 82.1% and specificity of RAMs ranged from 34.3% to 70.4%. Discrimination was poor, with an area under the receiver operating characteristic curve of less than 60% for all RAMs.<\/p>\n\n\n\n

Meaning<\/strong>  This study suggests that the accuracy and prognostic performance of the simplified Geneva score and other validated RAMs to predict VTE is limited and their clinical usefulness is thus questionable.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Thromboprophylaxis is recommended for medical inpatients at risk of venous thromboembolism (VTE). Risk assessment models (RAMs) have been developed to stratify VTE risk, but a prospective head-to-head comparison of validated RAMs is lacking.<\/p>\n\n\n\n

Objectives<\/strong>  To prospectively validate an easy-to-use RAM, the simplified Geneva score, and compare its prognostic performance with previously validated RAMs.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This prospective cohort study was conducted from June 18, 2020, to January 4, 2022, with a 90-day follow-up. A total of 4205 consecutive adults admitted to the general internal medicine departments of 3 Swiss university hospitals for hospitalization for more than 24 hours due to acute illness were screened for eligibility; 1352 without therapeutic anticoagulation were included.<\/p>\n\n\n\n

Exposures<\/strong>  At admission, items of 4 RAMs (ie, the simplified and original Geneva score, the Padua score, and the IMPROVE [International Medical Prevention Registry on Venous Thromboembolism] score) were collected. Patients were stratified into high and low VTE risk groups according to each RAM.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  Symptomatic VTE within 90 days.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Of 1352 medical inpatients (median age, 67 years [IQR, 54-77 years]; 762 men [55.4%]), 28 (2.1%) experienced VTE. Based on the simplified Geneva score, 854 patients (63.2%) were classified as high risk, with a 90-day VTE risk of 2.6% (n\u2009=\u200922; 95% CI, 1.7%-3.9%), and 498 patients (36.8%) were classified as low risk, with a 90-day VTE risk of 1.2% (n\u2009=\u20096; 95% CI, 0.6%-2.6%). Sensitivity of the simplified Geneva score was 78.6% (95% CI, 60.5%-89.8%) and specificity was 37.2% (95% CI, 34.6%-39.8%); the positive likelihood ratio of the simplified Geneva score was 1.25 (95% CI, 1.03-1.52) and the negative likelihood ratio was 0.58 (95% CI, 0.28-1.18). In head-to-head comparisons, sensitivity was highest for the original Geneva score (82.1%; 95% CI, 64.4%-92.1%), while specificity was highest for the IMPROVE score (70.4%; 95% CI, 67.9%-72.8%). After adjusting the VTE risk for thromboprophylaxis use and site, there was no significant difference between the high-risk and low-risk groups based on the simplified Geneva score (subhazard ratio, 2.04 [95% CI, 0.83-5.05];\u00a0P<\/em>\u2009=\u2009.12) and other RAMs. Discriminative performance was poor for all RAMs, with an area under the receiver operating characteristic curve ranging from 53.8% (95% CI, 51.1%-56.5%) for the original Geneva score to 58.1% (95% CI, 55.4%-60.7%) for the simplified Geneva score.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  This head-to-head comparison of validated RAMs found suboptimal accuracy and prognostic performance of the simplified Geneva score and other RAMs to predict hospital-acquired VTE in medical inpatients. Clinical usefulness of existing RAMs is questionable, highlighting the need for more accurate VTE prediction strategies.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Cardiology May 10,&nb […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25998"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25998"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25998\/revisions"}],"predecessor-version":[{"id":26361,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25998\/revisions\/26361"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25998"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25998"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25998"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}