| ObjectiveVenous Thromboembolism(VTE)is a chronic disease that often recurs,and it is also a largely preventable disease.VTE risk stratification assessment is the key to VTE prevention.At present,there are many existing VTE assessment tools,among which the Caprini model and Padua model have been recommended by relevant guidelines and applied in clinical practice;the Caprini model is recommended for the assessment of VTE risk stratification in surgical inpatients,and the Padua model is recommended for medical inpatients Evaluation of VTE risk stratification,but the key group of elderly hospitalized patients is outside the population recommended by the guidelines.According to the literature review,there is no unified VTE assessment tool specifically for the key group of elderly hospitalized patients.Therefore,this study selected two VTE assessment tools commonly used in clinical practice—the Caprini model and the Padua model,and compared the predictions of the two models.The effectiveness of VTE in elderly hospitalized patients;explore VTE assessment tools suitable for elderly hospitalized patients,and provide more accurate assessment tools for standardized prevention of VTE in elderly hospitalized patients.MethodsFrom June 1,2021 to August 31,2021,the medical records of 1,376 elderly inpatients in a tertiary hospital in Yunnan Province were retrospectively screened,and526 elderly inpatients who met the inclusion and exclusion criteria were included.There were 89 elderly inpatients diagnosed with VTE by CT pulmonary angiography,and 437 elderly inpatients without VTE;the patients diagnosed with VTE were divided into the VTE group,and the patients without VTE were divided into the non-VTE group.The general information of the patients was collected,and the risk factors were scored by using the Caprini and Padua models;the statistical analysis was carried out on the general information of the two groups of elderly hospitalized patients using SPSS software,the independent sample t test and the rank sum test were used for the quantitative data,and the cardinal sum test was used for the qualitative data.The Chi-square test was used to compare the implementation of preventive measures in different groups and different risk stratifications;the independent sample t-test was used to compare the scores of the Caprini model and the Padua model between the two groups of patients;the binary logistic regression was used to explore the Caprini model and the Padua model The correlation between the risk classification of the model and the occurrence of VTE;evaluation indicators such as sensitivity,specificity,and area under the ROC curve were used to compare the effects of the Caprini model and the Padua model on the risk of VTE in elderly hospitalized patients.Results(1)Comparing the implementation of preventive measures for elderly hospitalized patients in different groups: Among elderly hospitalized patients,the overall prevention rate of VTE reached 60%.In the VTE group,86 elderly hospitalized patients took preventive measures,and the prevention rate reached 93.3% %;in the non-VTE group,280 elderly hospitalized patients took preventive measures,and the prevention rate was64.1%.Statistical analysis showed that there was a statistical difference in the implementation of preventive measures between the two groups(χ2=29.45,P<0.05).(2)Comparing the implementation of preventive measures for elderly hospitalized patients in different models: scoring according to the risk factors in the Caprini model,in the middle-risk risk stratification,18 elderly hospitalized patients took preventive measures,and the prevention rate reached 81.8%;In the high-risk risk stratification,165 elderly hospitalized patients took preventive measures,with a prevention rate of 64.2%;in the very high-risk risk stratification,180 elderly hospitalized patients took preventive measures,with a prevention rate of 72.8%.The results of statistical analysis showed that there were statistical differences in the implementation of preventive measures among different risk stratifications in the Caprini model(χ2=6.190,P<0.005).Scored according to the risk factors in the Padua model,in the low-risk risk stratification,310 elderly hospitalized patients took preventive measures,and the VTE prevention rate reached67.4%;in the summary of high-risk risk stratification,53 elderly hospitalized patients took preventive measures The prevention rate was 80.3%;statistical analysis showed that there was a statistical difference in the implementation of preventive measures between the low-risk group and the high-risk group in the Padua model(χ2=4.499,P<0.05)(3)Comparing the two groups of patients Caprini and Padua Comparison of model scores: the average score of Caprini model(5.61±1.564)and Padua model(3.37±1.569)in the VTE group were significantly higher than those in the non-VTE group,and the difference was statistically significant(P<0.05).(4)Correlation between each risk stratification of the Caprini model and the occurrence of VTE: In the Caprini model,the risk of VTE in patients with a high-risk score of 3-4 and a very high-risk score ≥ 5was compared with that of a moderate-risk score of 2 The difference was statistically significant(P<0.05).(5)Correlation between each risk stratification of the Padua model and the occurrence of VTE: In the Padua model,with low-risk scores of 0-1 as reference,the risk of VTE in patients with low-risk scores of 2-3 and high-risk scores ≥ 4 is comparable to that of patients with low-risk scores of 0-1.There was a statistically significant difference between-1 points(P<0.05).(6)The areas under the ROC curves of the Caprini and Padua models were(0.732±0.028)and(0.769±0.030)respectively,and the areas under the ROC curves were statistically significant(P<0.05),indicating that the two models are meaningful in predicting VTE.The best cut-off value of the Caprini model is 4.5 points(sensitivity=0.843,specificity=0.588,Youden index=0.442),and the best cut-off value of the Padua model is 3.5 points(sensitivity=0.528,specificity=0.945,Youden index =0.473),the sensitivity of the Caprini model was higher than that of the Padua model,and there was no statistically significant difference in the area under the ROC curve between the two.Conclusions(1)The Caprini model has better accuracy in screening elderly hospitalized patients with VTE than the Padua model,and can accurately classify elderly hospitalized patients with VTE into corresponding risk stratification;Nurses can provide corresponding preventive measures for patients based on the results of risk stratification(2)This study recommends using the Caprini model to stratify the risk of VTE among elderly hospitalized patients in the internal medicine department. |
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