Research On The Application Of Deep Venous Thromboembolism Risk Assessment Tools In Non-Hospitalized Patients

Objective:A retrospective case-control study was performed to compare the predictive effect of the Caprini Risk Assessment Scale and the Padua Scale on the prediction of deep venous thrombosis in non-surgical ICU patients,and to determine the thrombus assessment scale with higher sensitivity and specificity.Risk factors of venous thrombosis,and clinical application research using this scale,to clarify the predictive value of the scale in deep venous thrombosis of non-surgical ICU patients,so as to achieve early identification of the risk of DVT,and to prevent deep Venous thrombosis provides a clinical basis.Method:Part oneA retrospective case-control study was used to select 154 non-surgical non-surgical DVT patients who were admitted to the ICU in a tertiary Class A hospital from January 2013 to December 2017 as the case group,and 154 non-surgical non-DVT patients as the control group..Collect clinical data of patients,laboratory tests,etc.The Caprini risk assessment scale and Padua scale were used to evaluate the risk of 308 non-surgical ICU patients.The sensitivity,specificity and area under the ROC curve(AUC)of the two risk assessment scales were tested,and the two risk assessment scales were compared.Predictive effect and optimal cutoff in non-surgical ICU patients.The t test was used for comparison between measurement data groups,and the 2 test was used for comparison between count data groups.Multi-factor conditional logistic regression model was used to screen risk factors,and the odds ratio(OR value)and its 95%confidence interval(95%CI)were calculated.Part twoA prospective cohort study method was used to continuously collect ICU non-surgical patients who met the selection criteria from October 2018 to June 2019.The Caprini Risk Assessment Scale was used to assess the risk of patients,and the basic data of the patients were collected to test the Caprini risk assessment Scale predictive value in non-surgical ICU patients.Result:Part oneThe Caprini risk assessment scale and the Padua scale have different effects in assessing deep vein thrombosis in non-surgical patients with ICU.The Caprini risk assessment scale selects 70.8%for high-risk DVT,and the Padua scale selects DVT for high-risk 44.8.%,The difference was statistically significant(P<0.05);the area under the ROC curve(AUC)(0.709[95%CI:0.652-0.767])of the Caprini risk assessment scale in non-surgical ICU patients was higher than that of Padua risk assessment The area under the ROC curve(AUC)of non-surgical patients in the ICU was(0.616[95%CI:0.553-0.679]),and the difference was statistically significant(Z=3.246,P<0.001).When the optimal cutoff value of the Caprini risk assessment scale is 7 points,the corresponding sensitivity and specificity are 70.8%and 62.3%,and the Jordan index is 0.331.When the optimal cutoff value of the Padua scale is 5 points,the corresponding The sensitivity and specificity were 32.19%and 85.63%,respectively,and the Jordan index was 0.221.Multi-factor conditional logistic regression showed that lower extremity edema,severe pulmonary diseases including pneumonia(within 1 month),Mechanical Ventilation,VTE history,and DVT in non-surgical patients were significantly different(P<0.05).Part twoA total of 258 non-surgical ICU patients who met the selection criteria were collected,of which 25 patients had DVT,and the incidence of DVT was 9.69%.Among them,left upper limb DVT was 10 cases(40%),right upper limb DVT was 7 cases(28%),bilateral lower limb DVT was 8 cases(32%);central DVT was 8 cases(32%),and peripheral DVT was 12 cases(48%),5 cases of mixed DVT(20%).The Caprini Risk Assessment Scale for non-surgical DVT in ICU patients shows that the risk of DVT in high-risk patients(≥7 points)is 6.939(95%CI:2.766-17.405)times lower than that in low-risk patients(<7 points).There was statistical significance(P<0.05).The area under the ROC curve of the Caprini scale was 0.715,the sensitivity was 0.72,the specificity was 0.73,the positive predictive value was 0.222,and the negative predictive value was 0.920.Conclusion:(1)When the optimal cutoff values of the Caprini risk assessment scale and the Padua scale are 7 and 5 respectively,the prediction accuracy is the best and the AUC is the largest.Both scales were able to predict deep venous thrombosis in non-surgical ICU patients.The AUR of the Caprini Risk Assessment Scale was higher than the Padua scale,indicating that the Caprini risk assessment scale is better than Padua in predicting deep vein thrombosis in non-surgical ICU patients.The scale is more effective.Lower extremity edema,severe lung disease including pneumonia(within 1 month),Mechanical Ventilation and VTE history are risk factors for deep vein thrombosis in non-surgical ICU patients.(2)The prevention of DVT in non-surgical patients in ICU has not reached the ideal state by medical staff.It is necessary to strengthen the awareness of DVT prevention among medical staff,identify early high-risk groups,and adopt a combination of physical prevention and drug prevention to strengthen basic prevention.Thereby effectively reducing the incidence of DVT.