Validation of a Patient-Completed Caprini Risk Score for Venous Thromboembolism Risk Assessment

Abstract

Introduction Individualized risk assessment for venous thromboembolism (VTE) using the Caprini risk score (CRS), coupled with targeted prophylaxis based on the score, is effective in reducing postoperative VTE. Critics contend that using this tool is time consuming for health care providers. We decided to create a patient-completed CRS and conducted a prospective study to compare the scores calculated by a patient with those calculated by a blinded physician for the same patient. Methods In phase 1, we interviewed patients in our deep vein thrombosis (DVT) support group who had a history of thrombosis and included their family members to determine areas of misunderstanding in the original CRS. We created a patientcompleted form based on these interviews. In phase 2, we further optimized the questions after a CRS-trained, blinded physician scored 20 hospitalized patients during the pilot study. In the final (third) phase, we measured the agreement level between the new form filled out by the trained physicians and those filled out by the patients. The study was approved by our local institutional review board. Using PASS version 11, we determined that a sample size of 37 individuals achieves a power of 80%, to detect a 0.1 difference between the null hypothesis correlation of 0.5 and the alternative hypothesis correlation of 0.7 using a two-sided hypothesis test with a significance level of 0.05. We tabulated the individuals' answers and categorized the scores by using SPSS version 23 to estimate the kappa value, linear correlation, and the Bland-Altman test. A kappa value greater than 0.8 indicated an "almost perfect agreement." Results We tested the first patient-completed CRS version (phase 2) in a 20-patient pilot study. A poor agreement was observed with the body mass index (BMI) responses in multiple iterations, and so we excluded the BMI calculation from the final patientcompleted CRS form. We recruited 42 patients with an average age of 55, mostly female (45%), who completed less than college education (62%) to fill out the updated CRS form

Completion of the Updated Caprini Risk Assessment Model (2013 Version)

“…The patient or the patient's health-care advocate should complete the risk assessment tool. 38 In 2017, Fuentes et al tested multiple versions of a patient-friendly Caprini risk score worksheet until they created a tool that, when completed first by the patient, and then by a physician trained to interpret the Caprini RAM, yielded a high correlation of agreement. The average time to complete the tool was 5 minutes for the patient and then 6 minutes for the physician to finalize the score.…”

Clinical Validation of the Chinese Version of Patient Completed Caprini Risk Assessment Form

“…The average time for patients to complete the form was 5 minutes, and for physicians was 6 minutes. 21 In 2018, Paz Rios et al translated the English version of patient-completed CRS into Spanish, Arabic, and Polish, and also found a strong correlation and an excellent agreement between patient-completed CRS and trained physician-completed CRS. Similarly, physicians only need to calculate BMI value, and the time for patients to fill the form was also about 6 minutes.…”

Direct Comparison of Patient-completed and Physician-completed Caprini Scores for Plastic Surgery Patients

“…The only risk factor left out of the patient-completed score sheet was body mass index, as it had been previously reported that patients inaccurately reported this value. 11 This risk factor was corrected for as necessary in patient-completed risk scores.…”