| Learning Objective #1: Identify eight factors that place a hospitalized patient at risk for venous thromboembolism | |||
| Learning Objective #2: Name four possible preventive interventions for patients at risk for venous thromboembolism |
OBJECTIVE: To identify risk factors at triage in emergency department patients who are at increased risk of developing a venous thromboembolism (VTE) while hospitalized.
METHODS: Design: Retrospective, observational, case control. Setting: Urban academic Level I medical center. Subjects: Cases were patients admitted to the hospital from the ED with a diagnosis other than a VTE who developed a VTE during hospitalization. Controls were patients admitted to the hospital who did not develop a VTE during hospitalization, matched on age and sex in a 1:3 ratio. Study period: 9/1/99 – 8/31/01. Diagnosis was confirmed by chart review. Major data elements - age, sex, length of stay, in-hospital VTE, prophylaxis, admitting diagnosis, history, co-morbid conditions, hospital activity level. Univariate analysis was performed to identify factors associated with in-hospital VTE, followed by multiple logistic regression to identify independent predictors.
RESULTS: 116 cases initially identified, 8 excluded due to symptomatology suggestive of VTE or VTE diagnosed within one day of hospital admission. There were 108 cases and 324 matched controls in the study. Ages ranged from 17-97. The following factors were identified as independent predictors of hospital-acquired VTE: Cancer (OR= 2.1, 95%CL = 1.1- 3.1), head trauma (17.8, 1.9-163.6), central IV line (3.3, 1.0-10.3), multiple trauma (7.3, 2.0-25.8), pneumonia(2.6, 1.0-6.6), seizures(1.6, .65-4.0), history of VTE(2.9, 1.2-7.3), hospital activity – bed rest(2.0, 2.4-6.8).
CONCLUSIONS: We have identified risk factors for developing in-hospital VTE. These risk factors should be identified at triage by the emergency nurse. Patients found to be at risk should be considered for VTE prophylaxis (ambulation, range of motion exercises, elastic stockings, circumfrential compression boots, and/or pharmacological interventions) that begins in the ED.
Lack of diagnostic studies to detect asymptomatic VTEs present on hospital admission limit the results of this study.
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