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Venous thromboembolism risk stratification for patients with lower limb trauma and cast or brace immobilization

Abstract :

BACKGROUND: Thromboprophylaxis for patients with non-surgical isolated lower-limb trauma requiring immobilization is a matter of debate. Our aim was to develop and validate a clinical risk- stratification model based on Trauma, Immobilization and Patients' characteristics (the TIP score).

METHODS: The TIP score criteria and the cut-off were selected by a consensus of international experts (n = 27) using the Delphi method. Retrospective validation was performed in a population-based case-control study (MEGA study). The potential score's impact in anticoagulant treatment was assessed in a prospective single-center observational cohort study.

FINDINGS: After four successive rounds, 30 items constituting the TIP score were selected: thirteen items for trauma, three for immobilization and 14 for patient characteristics were selected, each rated on a scale of 1 to 3. In the validation database, the TIP score had an AUC of 0·77 (95% CI 0.70 to 0.85). Using the cut-off proposed by the experts (≥5) and assuming a prevalence of 1·8%, the TIP scores had a sensitivity, specificity and negative predictive values of 89·9%, 30·7% and 99·4% respectively. In the prospective cohort, 84·2% (165/196) of all the patients concerned who presented at the emergency department had a low VTE risk not requiring thromboprophylaxis according to their TIP scores. The 3-month rate of symptomatic VTE was 1/196 [95% CI 0.1-2.8] this patient was in the sub-group TIP score ≥5.

CONCLUSION: For patients with non-surgical lower-limb trauma and orthopedic immobilization, the TIP score allows an individual VTE risk-assessment and shows promising results in guiding thromboprophylaxis.

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https://hal.univ-angers.fr/hal-02616952
Contributeur : Okina Université d'Angers <>
Soumis le : lundi 25 mai 2020 - 04:42:07
Dernière modification le : dimanche 25 octobre 2020 - 06:32:18

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Delphine Douillet, B Nemeth, Andrea Penaloza, Grégoire Le Gal, Thomas Moumneh, et al.. Venous thromboembolism risk stratification for patients with lower limb trauma and cast or brace immobilization. PLoS ONE, Public Library of Science, 2019, 14, pp.e0217748. ⟨10.1371/journal.pone.0217748⟩. ⟨hal-02616952⟩

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