DVT/PE Risk Assessments: All Are Not Equal, Quantitative Assessments Are Superior

Abstract

PURPOSE: Deep venous thrombosis [DVT] and Pulmonary Embolism [PE] are preventable complications. The joint commission mandates routine risk assessment in hospitalized patients. No comparison data between quantitative [Q] and non-quantitative [NQ] assessments is available. METHOD(S): we retrospectively analyzed 141 adult trauma patients seen at our level 1 center. All patients had NQ risk assessment performed and recorded. Risk category assignment using NQ was at physician discretion. We performed an additional Q risk assessment to compare with NQ and categorize accordingly. We compared Q versus NQ with regard to diagnostic accuracy as well as appropriateness of prophylaxis using one-way analysis of Variance {ANOVA} RESULTS: The NQ assessment uniformly underestimated risk, with the low risk NQ actually being moderate risk Q, the moderate risk NQ being High risk Q, the high risk NQ being Very High risk Q grouping. Using the NQ data to assess prophylaxis success in patients with no contraindication, we found that low, moderate and high risk groups had rates of 72 +/- 11 %, 65 +/- 8 %, and 58+/- 14% respectively [p=n.s.]. However when we looked at the same patients using Q data we found the prophylactic success more problematic especially with the very high risk group [prophylactic success of 100 % for the low risk, 83 +/- 11% for the moderate risk, 74 +/- 9% for the high risk but only 29+/- 9% for the very high risk group (p=0.001). symptomatic DVTs only occurred in high and very high risk groups [4+/- 3 %, and 6 +/- 3 % respectively] although statistical significance was not reached. CONCLUSION(S): A quantitative risk assessment provides greater accuracy and better therapeutic success assessment than non-quantitative assessments.