The Journal of the Association of Physicians of India · 2013
Risk stratification, prevalence by hand-held microdoppler and in-hospital mortality of deep venous thrombosis in indoor geriatric population.
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Palkar Atul V, Karnik N D
Аннотация
OBJECTIVE: To screen indoor geriatric patients for deep venous thrombosis (DVT) risk, assess them for the presence of DVT with hand-held microdoppler (HHMD) and correlate DVT risk score with inpatient mortality.
METHODS: 111 patients (> or = 60 years) admitted for > or = 72 hours [51 patients from intensive care unit (ICU) and 60 patients from general medical wards (GMW)] over 15 months were included. Patients with suspected venous thromboembolic disease on admission were excluded. On admission, patients were screened with HHMD for the presence of DVT; those with evidence of lower limb DVT were excluded. DVT risk was stratified using the SMART Tool and patients classified into mild (1), moderate (2), high (3-4) and very high (> or = 5) risk groups. Patients were screened periodically clinically and with HHMD for DVT till discharge. The effect of thromboprophylaxis (heparin) on all-cause mortality was correlated. Levene's test for equality of variances and Pearson's Chi-square test were used for statistical analysis.
RESULTS: Mean risk score (SMART TOOL) in study group was 5.15. Among 111 patients, 75 (67.56%) had high to very high risk for DVT. Immobilization, sepsis, heart failure, and acute coronary syndrome were most common risk factors for DVT. Only 2.7% of indoor geriatric patients had clinical evidence of DVT while 13.5% had presumptive evidence of DVT as detected by HHMD. The mean risk score for DVT in expired patients was higher than in discharged patients (p = 0.052). ICU patients receiving thromboprophylaxis had significantly lower mortality (9.5%) compared to those who did not (50%). (p = 0.004). Patients with presumptive evidence of DVT on HHMD had significantly higher mortality (53.33 percent) compared to those without evidence of DVT (15.62 percent); p < 0.05.
CONCLUSIONS: Indoor geriatric patients constitute high risk group for DVT. There could be an increased risk of mortality in patients with presumptive evidence of DVT on HHMD.
METHODS: 111 patients (> or = 60 years) admitted for > or = 72 hours [51 patients from intensive care unit (ICU) and 60 patients from general medical wards (GMW)] over 15 months were included. Patients with suspected venous thromboembolic disease on admission were excluded. On admission, patients were screened with HHMD for the presence of DVT; those with evidence of lower limb DVT were excluded. DVT risk was stratified using the SMART Tool and patients classified into mild (1), moderate (2), high (3-4) and very high (> or = 5) risk groups. Patients were screened periodically clinically and with HHMD for DVT till discharge. The effect of thromboprophylaxis (heparin) on all-cause mortality was correlated. Levene's test for equality of variances and Pearson's Chi-square test were used for statistical analysis.
RESULTS: Mean risk score (SMART TOOL) in study group was 5.15. Among 111 patients, 75 (67.56%) had high to very high risk for DVT. Immobilization, sepsis, heart failure, and acute coronary syndrome were most common risk factors for DVT. Only 2.7% of indoor geriatric patients had clinical evidence of DVT while 13.5% had presumptive evidence of DVT as detected by HHMD. The mean risk score for DVT in expired patients was higher than in discharged patients (p = 0.052). ICU patients receiving thromboprophylaxis had significantly lower mortality (9.5%) compared to those who did not (50%). (p = 0.004). Patients with presumptive evidence of DVT on HHMD had significantly higher mortality (53.33 percent) compared to those without evidence of DVT (15.62 percent); p < 0.05.
CONCLUSIONS: Indoor geriatric patients constitute high risk group for DVT. There could be an increased risk of mortality in patients with presumptive evidence of DVT on HHMD.