A Comparative Study Of Different Risk Assessment Tools For Acute Stroke Complicated With Deep Vein Thrombosis

Deep vein thrombosis(DVT)is one of the most common serious complications in patients with acute stroke.How to make timely and accurate risk assessment is the key to the reasonable implementation of later risk management.At present,there are many risk assessment tools for DVT in clinic application,but there is no applicable risk assessment tool for acute stroke at home and abroad.Therefore,through the systematic comparison of different DVT risk assessment tools in this paper,the most suitable DVT risk assessment tools for patients with acute stroke are selected,so as to provide the basis for the early intervention and hierarchical management of DVT in the future.Objective:By comparing the diagnostic accuracy and application value of 5 different DVT risk assessment tools to screen out the risk assessment scale that matches the characteristics of DVT in patients with acute stroke in China,and provide the basis for the systematic and standardized implementation of the early prevention and treatment of DVT by medical staff in neurology department.Methods:A prospective survey was conducted.489 patients with acute stroke in the the First Affiliated Hospital of Soochow University from November 2018 to November 2019 were selected by convenience sampling.The researchers used five different DVT risk assessment tools to assess the risk of patients within 24 hours after admission,and used the results of color Doppler ultrasound as the gold standard of DVT diagnosis,SPSS 23.0 and Medcalc were used to analyze the data,and the effectiveness and applicability of each evaluation tool were comprehensively measured from the perspectives of diagnosis efficiency,application value and the characteristics of missed diagnosis population.Results:1.In this study,489 acute stroke patients were enrolled,71 of whom had DVT.The incidence rate was 14.5%.In 71 patients with DVT,the main cause was intramuscular venous thrombosis at 60.6%.2.The results showed that the sensitivity,specificity,mistake diagnostic rate,omission diagnostic rate and the area under curve of five different DVT risk assessment tools were as follows:①The post-stroke DVT prediction system’s value was 84.5%,50.2%,49.8%,15.5%,0.731(0.689,0.770);②The post acute ischemic stroke isolated distal DVT risk assessment scale’s value was 76.1%,45.2%,54.8%,23.9%,0.692(0.649,0.733);③The Caprini 2005 risk assessment model’s value is 100.0%,0,100.0%,0,0.761(0.720,0.798);④ The Wells DVT score’s value is 85.9%,53.8%,46.2%,14.1%,0.776(0.737,0.813);⑤The Padua prediction score’s value is 83.1%,60.5%,39.5%,16.9%,0.769(0.729,0.805).Among them,the sensitivity of wells DVT score is better than other scales,and the specificity of Padua prediction score is better than other scales.The AUC values of different risk assessment tools indicate that the diagnostic value is moderate3.The item utilization rates of the post-stroke DVT prediction system,the post acute ischemic stroke isolated distal DVT risk assessment scale,the caprini 2005 risk assessment model,the wells DVT score and the Padua prediction score were 100.0%,100.0%,57.9%,90.0%and 90.6%,respectively,of which the item utilization and clinical operability of Padua predictive score were better than other scales.4.For 498 acute stroke patients with DVT positive,the missed diagnosis number of the post-stroke DVT prediction system,the post acute ischemic stroke isolated distal DVT risk assessment scale,the Caprini 2005 risk assessment model,the Wells DVT score,and the Padua prediction score were 11,17,0,10,12,respectively.Among them,the post-stroke DVT prediction system and the Wells DVT score were easy to miss diagnosis of "male" and "non-paralyzed" patients(P<0.05).The Padua prediction score was superior to the other tools for the missed diagnosis of high risk factors in DVT positive patients.Conclusion:Based on the multi-dimensional comparison of the diagnostic efficacy,items’application value and the analysis results of the characteristics of the missed diagnosis population of five different DVT risk assessment tools,it is found that the Padua prediction score is more suitable for the DVT after acute stroke,and has more guiding significance for the application of clinical DVT prevention measures.