Implementation of an electronic medical record tool for early detection of deep vein thrombosis in the ambulatory oncology setting

Abstract

Background Venous thromboembolism ( VTE ) is a major cause of morbidity, mortality, and hospitalization in cancer patients. Objectives To evaluate the feasibility of an electronic alert to identify and screen at‐risk individuals and gather rates of early detection of deep vein thrombosis ( DVT ). Patients/Methods An alert was built into the electronic medical record based on a validated risk tool (Khorana Score [ KS ]) and outcomes evaluated in an initial silent phase. The alert functioned in real time to warn physicians of high‐risk patients ( KS ≥ 3) and suggested lower extremity screening ultrasonography in a subsequent active phase. Results Of 194 consecutive patients identified as high risk in the silent phase, 14 (7.2%) developed subsequent DVT or pulmonary embolism ( PE ) over 90‐day follow‐up, with a median of 27 days. Mean 90‐day emergency room ( ER ) visits, all‐cause admissions, and length of stay (days) for patients with DVT were 1.2, 1.6, and 9.1 compared to 0.89, 0.93, and 5.1 for all patients, respectively. In the active phase, 197 consecutive alerts met inclusion criteria, and 40 patients (20.3%) received a screening ultrasound. Five (12.5%) had a DVT and were started on therapeutic anticoagulation. Of patients with alerts who had screening deferred, 13 (8.3%) were later diagnosed with DVT (median 50.5 days) and 7 (4.5%) with PE . Conclusion An automated alert may have value in early detection of DVT in high‐risk cancer patients leading to earlier intervention, and could potentially prevent VTE ‐related morbidity.

Validation of the Khorana Score to Assess Venous Thromboembolism and Its Association with Mortality in Cancer Patients: A Retrospective Community-based Observational Experience

“…While multiple studies have validated the KS as a predictive tool for chemotherapy-associated VTE, there are some studies that say otherwise [9,[14][15][16][17][18]. Our study validated KS in a community setting with a predominant elderly population and showed that high KS as well as intermediate KS was associated with increased odds of VTE but only high KS when compared to low KS was statistically significant (p=0.032).…”

Morphological changes in the venous wall under experimental neoplastic intoxication

“…На аутопсії, ознаки тромбоемболічних ускладнень виявляються майже у половини онкологічних пацієнтів, ТЕЛА є причиною смерті у 15% хворих, що страждають на онкопатологію [1]. У сучасних дослідженнях доведено, що онкологічне захворювання підвищує ризик тромбозу глибоких вен та ТЕЛА в 4-7 разів [2,3]. Характерною особливістю тромбоемболічних ускладнень у пацієнтів з онкологічними захворюваннями є те, що тромбоз глибоких вен та тромбофлебіт поверхневих вен нижніх кінцівок погано піддаються медикаментозному лікуванню, є причиною зниження ефективності та нерідко, припинення лікування основного захворювання [4,5,6].…”

Prediction and Prevention of Cancer-Associated Thromboembolism

“…A similar EMR tool was developed by investigators in the U.S. to identify high‐risk patients for early detection. To better comply with new guidelines, this tool is currently being refashioned to recommend prophylaxis [42]. Most recently, U.S. investigators developed and deployed a model of care for VTE prevention in an outpatient clinic that included nurses, advanced practice providers, pharmacists, hematologists, oncologists, and the EMR to increase compliance with guidelines [43].…”