| Background:hospital-acquired venousthromboembolism(HA-VTE)is one of the most common preventable causes of death in hospitalized patients,yet the rate of in-hospital prevention is low.In recent years,clinical decision support system(CDSS)has been gradually applied to assist doctors in the prevention of HA-VTE,but its effectiveness studies are still few.Objective:To study the effectiveness of prevention and control of HA-VTE based on clinical decision support system(CDSS).Methods:Demographic data,clinical characteristics,laboratory and imaging data of adult patients hospitalized in the Second Affiliated Hospital of Guangzhou Medical University from January 1,2017 to December 31,2021 were retrospectively analyzed to evaluate the incidence of HA-VTE before and after the adoption of CDSS based HA-VTE prevention in our hospital from January 1,2019.Changes in the clinical and anatomical distribution of HA-VTE-related adverse events.In this study,HA-VTE was only included in hospital-acquired lower extremity deep venous thromboembolism,HA-LEDVT)and hospital-acquired pulmonary thromboembolism(HA-PTE).Results:A total of 1645 patients with HA-VTE were selected from 391,667 eligible inpatients in the Second Affiliated Hospital of Guangzhou Medical University from January 1,2017 to December 31,2021.The incidence of HA-VTE was 4.2‰,including 1549 patients with HA-LEDVT and 136 patients with HA-PTE.The incidence rates were 4.0‰ and 0.35‰,respectively.The incidence of HA-LEDVT accompanied by HA-PTE was 0.10‰.The in-hospital fatality rate was 8.1%,the all-cause mortality rate was 14%,and the all-cause mortality rate was 2.8% for HA-VTE.Female HA-VTE patients accounted for 52%,with an incidence of 4.2‰,equal to that of male patients.The median age of onset was 71 years old.As the age of onset of HA-VTE patients increased,the incidence of HA-VTE gradually increased and the proportion of patients gradually increased.Patients ≥60 years old accounted for 77%;patients 50-59,60-69,70-79 years old accounted for 15.3%,21.3%,27.2%,28.5%,respectively.The incidence rates of HA-VTE were 3.5‰,4.2‰,8.3‰ and13.1‰,respectively.Surgical patients accounted for 54%,and the incidence of HA-VTE was 4.3‰,which was higher than that of non-surgical patients.The top five departments with the incidence of HA-VTE were ICU.Department of Rehabilitation;General practice;Neurosurgery;In general emergency department,the incidence of HA-VTE was 53.4‰,29.4‰,24.7‰,16.4‰ and 15.1‰,respectively.In HA-LEDVT,pure left lower limb DVT accounted for 37.9%,pure right lower limb DVT accounted for 26.8%,and double lower limb DVT accounted for 28.3%.The incidence of HA-LEDVT in left lower limb was higher than that in right lower limb.Proximal DVT accounted for 13.4%,distal DVT 72.3% and hybrid DVT 14.3%.The proportion of isolated distal DVT was significantly higher than that of proximal DVT and hybrid DVT.The incidence of HA-VTE and HA-LEDVT increased gradually from 2.4‰ and2.2‰ in 2017 to 6.0‰ and 5.8% in 2021.The incidence of HA-VTE and HA-LEDVT after prevention and control was significantly higher than that before prevention and control(5.1‰vs3.1‰,2=94.55,P=0.001;4.8‰vs2.9‰,2=90.17,P=0.001).The incidence of HA-PTE decreased from 0.39‰ in 2018 to 0.31‰ in 2021.The incidence of HA-PTE decreased after prevention and control compared with that before prevention and control,but there was no statistical difference(0.34‰VS0.36‰,2=0.10,P=0.75).The incidence of HA-LEDVT co-occurring HA-PTE decreased from 0.19‰ in 2018 to 0.11‰ in 2021,and the incidence of HA-LEDVT co-occurring HA-PTE decreased significantly by 0.09‰ after prevention and control compared with that before prevention and control,with significant statistical difference(0.07‰vs0.16‰,2=7.14,P=0.008).Mortality and all-cause mortality of HA-PTE and HA-VTE decreased after prevention and control,but there was no statistical difference(6.6%vs10%,2=0.53,P=0.47;11.8%vs16.7%,2=0.65,P=0.42;2.3%vs3.9%,2=3.37,P=0.07).The top five departments with the incidence of HA-VTE after prevention and control were ICU,rehabilitation department,general medicine department,neurosurgery department and emergency general department.While the overall HA-VTE was on the rise,the incidence rate of HA-VTE in the departments of respiratory medicine,rehabilitation,urology,general surgery,gastroenterology,infection and general practice decreased compared with that before prevention and control.There were no statistically significant differences in gender,age distribution and limb distribution between the two groups before and after prevention and control(P > 0.05),and there were statistically significant differences in whether or not to have surgery and VTE composition(P < 0.05).The proportion of HA-LEDVT patients increased significantly after control compared with before control(93.4%vs88.8%,2=10.11,P=0.001),while the proportion of HA-PTE patients decreased significantly compared with before control(6.6%vs11.2%,2=10.11,P=0.001).The incidence of left and right HA-LEDVT after control was significantly higher than that before control(3.1‰vs1.9‰,2=55.78,P=0.001;3.0‰vs1.7‰,2=72.46,P=0.001);The proportion of isolated distal HA-LEDVT after prevention and control was significantly higher than that before prevention and control(78.6%vs57.8%,2= 87.78,P=0.001),and the incidence was significantly increased(4.9‰vs2.1‰,2=203.90,P=0.001).The proportion of proximal and mixed HA-LEDVT decreased significantly(21.4%vs42.2%,2=87.78,P=0.001),and the incidence of Ha-Ledvt decreased,but there was no statistical difference(1.3‰vs1.5‰,2= 2.38,P=0.12).After prevention and control,the proportion of HA-LEDVT with single segment vein involvement was significantly increased(73.0%vs56.8%,2=50.90,P=0.001),while the proportion of HA-LEDVT with ≥2 segment vein involvement was significantly decreased(27%vs43.2%,2=50.90,P=0.001).After prevention and control,the proportion of simple intermuscular vein involvement of distal HA-LEDVT increased significantly compared with that before prevention and control(77.0%vs63.5%,2=24.97,P=0.001),and the incidence of simple intermuscular vein involvement increased significantly(3.7‰vs1.3‰,2=208.69,P=0.001).After prevention and control,the cumulative incidence of HA-LEDVT involving popliteal,total femoral,superficial femoral,deep femoral and iliac vein had no significant change compared with before prevention and control(2.88‰vs2.92‰,2=0.05,P=0.82),while the cumulative incidence of HA-LEDVT involving subpatellar vein was significantly increased compared with before prevention and control(5.4‰vs V3.3‰,2=98.45,P=0.001).After prevention and control,481 of 1133 HA-VTE patients received VTE risk assessment,accounting for 42.5%.From January 1,2019 to December 31,2021,the highest monthly risk assessment rate for VTE was 49.9% and the average monthly risk assessment rate was 33.3%.Among high-risk patients assessed as VTE,the highest monthly prevention rate was 39.4% and the average monthly prevention rate was 20.7%.Conclusion:1.The incidence and all-cause mortality of HA-VTE in hospital were relatively high in hospitalized patients.The incidence of HA-VTE mainly occurred in elderly patients ≥60,and the incidence gradually increased with the increase of age.The departments with high incidence of HA-VTE include intensive care,neurosurgery,general emergency,rehabilitation and general practice.2.After in-hospital VTE prevention and control based on clinical decision support system(CDSS),the incidence of HA-LEDVT accompanied by HA-PTE was significantly reduced,the incidence of HA-PTE,HA-PTE mortality and all-cause mortality,HA-VTE all-cause mortality,and the incidence of proximal and mixed types of HA-LEDVT were reduced.However,the incidence of isolated distal HA-LEDVT is significantly increased,which may be mainly reflected in the improvement of doctors’ vigilance to hospital VTE and the detection rate of isolated distal HA-LEDVT,and the reduction of proximal spread of thrombosis and the occurrence of PTE through timely treatment.3.In order to better exert the prevention and control effect of hospital VTE prevention and control system based on clinical decision support system(CDSS),the improvement of VTE evaluation rate and prevention rate is an important quality control index. |
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