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Cohort study of prediction of venous thromboembolism in emergency department patients with extremity symptoms

Gottsäter, Anders LU ; Ekelund, Ulf LU orcid ; Melander, Olle LU orcid ; Björkelund, Anders LU and Ohlsson, Bodil LU (2024) In Internal and Emergency Medicine
Abstract

Despite diagnostic algorithms, identification of venous thromboembolism (VTE) in emergency departments (ED) remains a challenge. We evaluated symptoms, background, and laboratory data in 27,647 ED patients presenting with pain, swelling, or other symptoms from the extremities, and identified predictors of VTE diagnosis within one year. Predictors of a clinical decision to perform phlebography, ultrasound, or computer tomography (CT) angiography of pelvic, lower, or upper extremity veins, CT of pulmonary arteries, or pulmonary scintigraphy at the ED or within 30 days, and the results of such investigations were also evaluated. A total of 3195 patients (11.6%) were diagnosed with VTE within one year. In adjusted analysis of patients in... (More)

Despite diagnostic algorithms, identification of venous thromboembolism (VTE) in emergency departments (ED) remains a challenge. We evaluated symptoms, background, and laboratory data in 27,647 ED patients presenting with pain, swelling, or other symptoms from the extremities, and identified predictors of VTE diagnosis within one year. Predictors of a clinical decision to perform phlebography, ultrasound, or computer tomography (CT) angiography of pelvic, lower, or upper extremity veins, CT of pulmonary arteries, or pulmonary scintigraphy at the ED or within 30 days, and the results of such investigations were also evaluated. A total of 3195 patients (11.6%) were diagnosed with VTE within one year. In adjusted analysis of patients in whom all laboratory data were available, a d-dimer value ≥ 0.5 mg/l (odds ratio [OR]: 2.602; 95% confidence interval [CI] 1.894–3.575; p < 0.001) at the ED and a previous diagnosis of VTE (OR: 6.037; CI 4.465–8.162; p < 0.001) independently predicted VTE within one year. Of diagnosed patients, 2355 (73.7%) had undergone imaging within 30 days after the ED visit and 1730 (54.1%) were diagnosed at this examination. Lower age (OR: 0.984; CI 0.972–0.997; p = 0.014), higher blood hemoglobin (OR: 1.023; CI 1.010–1.037; p < 0.001), C-reactive protein (OR: 2.229; CI 1.433–3.468; p < 0.001), d-dimer (OR: 8.729; CI 5.614–13.574; p < 0.001), and previous VTE (OR: 7.796; CI 5.193–11.705; p < 0.001) predicted VTE on imaging within 30 days, whereas female sex (OR 0.602 [95% CI 0.392–0.924]; p = 0.020) and a previous diagnosis of ischemic heart disease (OR 0.254 [95% CI 0.113–0.571]; p = 0.001) were negative predictors of VTE. In conclusion, analysis of 27,647 ED patients with extremity symptoms confirmed the importance of well-established risk factors for VTE. Many patients developing VTE within one year had initial negative imaging, highlighting the importance of continued symptom vigilance.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Deep vein thrombosis, Prediction, Pulmonary embolism, Venous thromboembolism
in
Internal and Emergency Medicine
publisher
Springer
external identifiers
  • pmid:38954105
  • scopus:85197413468
ISSN
1828-0447
DOI
10.1007/s11739-024-03696-3
project
AIR Lund - Artificially Intelligent use of Registers
language
English
LU publication?
yes
id
f184b359-7356-4f6b-bfa7-566f90cfc88c
date added to LUP
2024-11-28 15:15:57
date last changed
2025-05-30 03:00:14
@article{f184b359-7356-4f6b-bfa7-566f90cfc88c,
  abstract     = {{<p>Despite diagnostic algorithms, identification of venous thromboembolism (VTE) in emergency departments (ED) remains a challenge. We evaluated symptoms, background, and laboratory data in 27,647 ED patients presenting with pain, swelling, or other symptoms from the extremities, and identified predictors of VTE diagnosis within one year. Predictors of a clinical decision to perform phlebography, ultrasound, or computer tomography (CT) angiography of pelvic, lower, or upper extremity veins, CT of pulmonary arteries, or pulmonary scintigraphy at the ED or within 30 days, and the results of such investigations were also evaluated. A total of 3195 patients (11.6%) were diagnosed with VTE within one year. In adjusted analysis of patients in whom all laboratory data were available, a d-dimer value ≥ 0.5 mg/l (odds ratio [OR]: 2.602; 95% confidence interval [CI] 1.894–3.575; p &lt; 0.001) at the ED and a previous diagnosis of VTE (OR: 6.037; CI 4.465–8.162; p &lt; 0.001) independently predicted VTE within one year. Of diagnosed patients, 2355 (73.7%) had undergone imaging within 30 days after the ED visit and 1730 (54.1%) were diagnosed at this examination. Lower age (OR: 0.984; CI 0.972–0.997; p = 0.014), higher blood hemoglobin (OR: 1.023; CI 1.010–1.037; p &lt; 0.001), C-reactive protein (OR: 2.229; CI 1.433–3.468; p &lt; 0.001), d-dimer (OR: 8.729; CI 5.614–13.574; p &lt; 0.001), and previous VTE (OR: 7.796; CI 5.193–11.705; p &lt; 0.001) predicted VTE on imaging within 30 days, whereas female sex (OR 0.602 [95% CI 0.392–0.924]; p = 0.020) and a previous diagnosis of ischemic heart disease (OR 0.254 [95% CI 0.113–0.571]; p = 0.001) were negative predictors of VTE. In conclusion, analysis of 27,647 ED patients with extremity symptoms confirmed the importance of well-established risk factors for VTE. Many patients developing VTE within one year had initial negative imaging, highlighting the importance of continued symptom vigilance.</p>}},
  author       = {{Gottsäter, Anders and Ekelund, Ulf and Melander, Olle and Björkelund, Anders and Ohlsson, Bodil}},
  issn         = {{1828-0447}},
  keywords     = {{Deep vein thrombosis; Prediction; Pulmonary embolism; Venous thromboembolism}},
  language     = {{eng}},
  publisher    = {{Springer}},
  series       = {{Internal and Emergency Medicine}},
  title        = {{Cohort study of prediction of venous thromboembolism in emergency department patients with extremity symptoms}},
  url          = {{http://dx.doi.org/10.1007/s11739-024-03696-3}},
  doi          = {{10.1007/s11739-024-03696-3}},
  year         = {{2024}},
}