Venous thromboembolism risk stratification for patients with lower limb trauma and cast or brace immobilization.
<h4>Background</h4>Thromboprophylaxis for patients with non-surgical isolated lower-limb trauma requiring immobilization is a matter of debate. Our aim was to develop and validate a clinical risk- stratification model based on Trauma, Immobilization and Patients' characteristics (th...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2019-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0217748 |
| _version_ | 1819029056681672704 |
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| author | D Douillet B Nemeth A Penaloza G Le Gal T Moumneh S C Cannegieter P M Roy |
| author_facet | D Douillet B Nemeth A Penaloza G Le Gal T Moumneh S C Cannegieter P M Roy |
| author_sort | D Douillet |
| collection | DOAJ |
| description | <h4>Background</h4>Thromboprophylaxis for patients with non-surgical isolated lower-limb trauma requiring immobilization is a matter of debate. Our aim was to develop and validate a clinical risk- stratification model based on Trauma, Immobilization and Patients' characteristics (the TIP score).<h4>Methods</h4>The TIP score criteria and the cut-off were selected by a consensus of international experts (n = 27) using the Delphi method. Retrospective validation was performed in a population-based case-control study (MEGA study). The potential score's impact in anticoagulant treatment was assessed in a prospective single-center observational cohort study.<h4>Findings</h4>After four successive rounds, 30 items constituting the TIP score were selected: thirteen items for trauma, three for immobilization and 14 for patient characteristics were selected, each rated on a scale of 1 to 3. In the validation database, the TIP score had an AUC of 0·77 (95% CI 0.70 to 0.85). Using the cut-off proposed by the experts (≥5) and assuming a prevalence of 1·8%, the TIP scores had a sensitivity, specificity and negative predictive values of 89·9%, 30·7% and 99·4% respectively. In the prospective cohort, 84·2% (165/196) of all the patients concerned who presented at the emergency department had a low VTE risk not requiring thromboprophylaxis according to their TIP scores. The 3-month rate of symptomatic VTE was 1/196 [95% CI 0.1-2.8] this patient was in the sub-group TIP score ≥5.<h4>Conclusion</h4>For patients with non-surgical lower-limb trauma and orthopedic immobilization, the TIP score allows an individual VTE risk-assessment and shows promising results in guiding thromboprophylaxis. |
| first_indexed | 2024-12-21T06:08:12Z |
| format | Article |
| id | doaj.art-5ae1e0d648874aa387c24228fbb47ef2 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T06:08:12Z |
| publishDate | 2019-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-5ae1e0d648874aa387c24228fbb47ef22022-12-21T19:13:36ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01146e021774810.1371/journal.pone.0217748Venous thromboembolism risk stratification for patients with lower limb trauma and cast or brace immobilization.D DouilletB NemethA PenalozaG Le GalT MoumnehS C CannegieterP M Roy<h4>Background</h4>Thromboprophylaxis for patients with non-surgical isolated lower-limb trauma requiring immobilization is a matter of debate. Our aim was to develop and validate a clinical risk- stratification model based on Trauma, Immobilization and Patients' characteristics (the TIP score).<h4>Methods</h4>The TIP score criteria and the cut-off were selected by a consensus of international experts (n = 27) using the Delphi method. Retrospective validation was performed in a population-based case-control study (MEGA study). The potential score's impact in anticoagulant treatment was assessed in a prospective single-center observational cohort study.<h4>Findings</h4>After four successive rounds, 30 items constituting the TIP score were selected: thirteen items for trauma, three for immobilization and 14 for patient characteristics were selected, each rated on a scale of 1 to 3. In the validation database, the TIP score had an AUC of 0·77 (95% CI 0.70 to 0.85). Using the cut-off proposed by the experts (≥5) and assuming a prevalence of 1·8%, the TIP scores had a sensitivity, specificity and negative predictive values of 89·9%, 30·7% and 99·4% respectively. In the prospective cohort, 84·2% (165/196) of all the patients concerned who presented at the emergency department had a low VTE risk not requiring thromboprophylaxis according to their TIP scores. The 3-month rate of symptomatic VTE was 1/196 [95% CI 0.1-2.8] this patient was in the sub-group TIP score ≥5.<h4>Conclusion</h4>For patients with non-surgical lower-limb trauma and orthopedic immobilization, the TIP score allows an individual VTE risk-assessment and shows promising results in guiding thromboprophylaxis.https://doi.org/10.1371/journal.pone.0217748 |
| spellingShingle | D Douillet B Nemeth A Penaloza G Le Gal T Moumneh S C Cannegieter P M Roy Venous thromboembolism risk stratification for patients with lower limb trauma and cast or brace immobilization. PLoS ONE |
| title | Venous thromboembolism risk stratification for patients with lower limb trauma and cast or brace immobilization. |
| title_full | Venous thromboembolism risk stratification for patients with lower limb trauma and cast or brace immobilization. |
| title_fullStr | Venous thromboembolism risk stratification for patients with lower limb trauma and cast or brace immobilization. |
| title_full_unstemmed | Venous thromboembolism risk stratification for patients with lower limb trauma and cast or brace immobilization. |
| title_short | Venous thromboembolism risk stratification for patients with lower limb trauma and cast or brace immobilization. |
| title_sort | venous thromboembolism risk stratification for patients with lower limb trauma and cast or brace immobilization |
| url | https://doi.org/10.1371/journal.pone.0217748 |
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