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Original Investigation |

Validation of the Caprini Venous Thromboembolism Risk Assessment Model in Critically Ill Surgical Patients

Andrea T. Obi, MD1; Christopher J. Pannucci, MD, MS2; Andrew Nackashi, BS3; Newaj Abdullah, BS4; Rafael Alvarez, MD5; Vinita Bahl, DMD, MPP5; Thomas W. Wakefield, MD5; Peter K. Henke, MD5
[+] Author Affiliations
1Section of Vascular Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor
2Division of Plastic Surgery, Department of Surgery, University of Utah, Salt Lake City
3West Virginia School of Osteopathic Medicine, Lewisburg
4Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
5Office of Performance Assessment and Clinical Effectiveness, University of Michigan Health System, Ann Arbor
JAMA Surg. 2015;150(10):941-948. doi:10.1001/jamasurg.2015.1841.
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Importance  Appropriate risk stratification for venous thromboembolism (VTE) is essential to providing appropriate thromboprophylaxis and avoiding morbidity and mortality.

Objective  To validate the Caprini VTE risk assessment model in a previously unstudied high-risk cohort: critically ill surgical patients.

Design, Setting, and Participants  We performed a retrospective cohort study of 4844 adults (≥18 years old) admitted to a 20-bed surgical intensive care unit in a large tertiary care academic hospital during a 5-year period (July 1, 2007, through June 30, 2012).

Main Outcomes and Measures  The main study outcome was VTE (defined as patients with deep vein thrombosis or pulmonary embolism) that occurred during the patient’s initial hospital admission.

Results  The study population was distributed among risk levels as follows: low, 5.3%; moderate, 19.9%; high, 31.6%; highest, 25.4%; and superhigh, 14.9%. The overall incidence of inpatient VTE was 7.5% and increased with risk level: 3.5% in low-risk patients, 5.5% in moderate-risk patients, 6.6% in high-risk patients, 8.6% in highest-risk patients, and 11.5% in superhigh-risk patients. Patients with Caprini scores greater than 8 were significantly more likely to develop inpatient VTE events when compared with patients with Caprini scores of 7 to 8 (odds ratio [OR], 1.37; 95% CI, 1.02-1.85; P = .04), 5 to 6 (OR, 1.35; 95% CI, 1.16-1.57; P < .001), 3 to 4 (OR, 1.30; 95% CI, 1.16-1.47; P < .001), or 0 to 2 (OR, 1.37; 95% CI, 1.16-1.64; P < .001). Similarly, patients with Caprini scores of 7 to 8 were significantly more likely to develop inpatient VTE when compared with patients with Caprini scores of 5 to 6 (OR, 1.33; 95% CI, 1.01-1.75; P = .04), 3 to 4 (OR, 1.27; 95% CI, 1.08-1.51; P = .005), or 0 to 2 (OR, 1.38; 95% CI, 1.10-1.74; P = .006).

Conclusions and Relevance  The Caprini VTE risk assessment model is valid. This study supports the use of individual risk assessment in critically ill surgical patients.

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Figure 1.
Caprini Scores and Venous Thromboembolism (VTE) Rates

Left, Caprini scores among the 4844 surgical intensive care unit (SICU) patients. Right, VTE rates according to Caprini risk stratification.

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Figure 2.
Rate of Venous Thromboembolism (VTE) Among Different Surgical Patient Populations by 2005 Caprini Risk Assessment Model Stratification

SICU indicates surgical intensive care unit.

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