Comparison of VTE risk scores in guidelines for VTE diagnosis in nonsurgical hospitalized patients with suspected VTE

Abstract

Background The assessment of VTE likelihood with VTE risk scores is essential prior to imaging examinations during VTE diagnostic procedure. Little is known with respect to the disparity of predictive power for VTE diagnosis among VTE risk scores in guidelines for nonsurgical hospitalized patients with clinically suspected VTE. Methods A retrospective study was performed to compare the predictive power for VTE diagnosis among the Wells, Geneva, YEARS, PERC, Padua, and IMPROVE scores in the leading authoritative guidelines in nonsurgical hospitalized patients with suspected VTE. Results Among 3168 nonsurgical hospitalized patients with suspected VTE, VTE was finally excluded in 2733(86.3%) ones, whereas confirmed in 435(13.7%) ones. The sensitivity and specificity resulted from the Wells, Geneva, YEARS, PERC, Padua, and IMPROVE scores were (90.3%, 49.8%), (88.7%, 53.6%), (73.8%, 50.2%), (97.7%,16.9%), (80.9%, 44.0%), and (78.2%, 47.0%), respectively. The YI were 0.401, 0.423, 0.240, 0.146, 0.249, and 0.252 for the Wells, Geneva, YEARS, PERC, Padua, and IMPROVE scores, respectively. The C-index were 0.694(0.626–0.762), 0.697(0.623–0.772), 0.602(0.535–0.669), 0.569(0.486–0.652), 0.607(0.533–0.681), and 0.609(0.538–0.680) for the Wells, Geneva, YEARS, PERC, Padua, and IMPROVE scores, respectively. Consistency was significant in the pairwise comparison of Wells vs Geneva(Kappa 0.753, P = 0.565), YEARS vs Padua(Kappa 0.816, P = 0.565), YEARS vs IMPROVE(Kappa 0.771, P = 0.645), and Padua vs IMPROVE(Kappa 0.789, P = 0.812), whereas it did not present in the other pairs. The YI was improved to 0.304, 0.272, and 0.264 for the PERC(AUC 0.631[0.547–0.714], P = 0.006), Padua(AUC 0.613[0.527–0.700], P = 0.017), and IMPROVE(AUC 0.614[0.530–0.698], P = 0.016), with a revised cutoff of 5 or less, 6 or more, and 4 or more denoting the VTE-likely, respectively. Conclusions For nonsurgical hospitalized patients with suspected VTE, the Geneva and Wells scores perform best, the PERC scores performs worst despite its significantly high sensitivity, whereas the others perform intermediately, albeit the absolute predictive power of all isolated scores are mediocre. The predictive power of the PERC, Padua, and IMPROVE scores are improved with revised cutoffs.

Risk Scores in Venous Thromboembolism Guidelines of ESC, ACCP, and ASH: An Updated Review

“…In previous studies, although each one among these 4 scores combined with D-dimer (DD) yields considerable sensitivity or safety and varying specificity in different healthcare settings or subgroups defined by sex, age, cancer, and previous VTE, 9 , 10 their diagnostic efficiency for VTE occurrence is moderate provided not combined with DD. 11 , 12 …”

The Benefits and Imperative of Venous Thromboembolism Risk Screening for Hospitalized Patients: A Systematic Review

“…The results of the extraction (Table 1) provide valuable insights into the characteristics and findings of the 12 included studies in this systematic review on the benefits of venous thromboembolism (VTE) risk assessment on hospitalized patients [32][33][34][36][37][38][39][40][41][42][43]45]. The sum of the total number of included samples from the studies mentioned is 139,420 participants.…”

“…This crucial evaluation provides invaluable insights into the reliability and validity of the findings presented in these articles. Notably, the majority of the studies [32][33][34][35][36]40,41,43,45] exhibit commendably low risks of bias across multiple critical domains. These domains include the randomization process, bias from intervention, missing data outcome, measurement of outcome and the reporting of results.…”

“…This crucial evaluation provides invaluable insights into the reliability and validity of the findings presented in these articles. Notably, the majority of the studies [32][33][34][35][36]40,41,43,45] exhibit commendably low risks of bias across multiple critical domains. These domains include the randomization process, bias from foundations with low risks of bias across multiple domains, it is vital for this systematic review to transparently acknowledge and critically assess the concerns identified in the two studies [37,38], with bias concerns and the single study (Modi et al, 2016) exhibiting high randomization bias.…”

Thrombosis and Bleeding Risk Scores Are Strongly Associated with Mortality in Hospitalized Patients with COVID-19: A Multicenter Cohort Study

“…The IMPROVE risk score of VTE (IMPROVE VTE ) [ 11 , 12 , 13 , 14 ] summed the following risk factors: previous VTE (3 points), known thrombophilia (2 points), current lower-limb paralysis (2 points), current cancer (2 points), immobilized more than a week (1 point), admitted to intensive care unit or equivalent (1 point), and age > 60 years (1 point). IMPROVE VTE scores of ≥4, 2–3, and 0–1 were categorized as high, moderate, and low VTE risk, respectively.…”