Journal
PHLEBOLOGY
Volume 36, Issue 10, Pages 827-834Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/02683555211021226
Keywords
Venous thromboembolism; risk assessment model; risk stratification; thromboprophylaxis; interobserver reliability
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Funding
- Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)
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In a population of adult acutely-ill medical patients, there was substantial to almost perfect inter-observer reliability in assessing risk factors and risk classification for venous thromboembolism (VTE). However, lead clinicians tended to underestimate the risk for VTE despite this high reliability.
Objectives To analyze the inter-observer reliability of risk for venous thromboembolism (VTE) in a population of adult acutely-ill medical patients. Methods In this prospective cohort study, we collected risk factors and risk classification for VTE using RAM IMPROVE7. Kappa statistics was used to evaluate inter-observer reliability between lead clinicians and trained researchers. We evaluated occurrence of VTE in patients with mismatched classification. Results We included 2,380 patients, median age 70 years (interquartile range [IQR], 58-79), 56.2% female. Adjusted Kappa for VTE risk factors ranged from substantial (0.64, 95% confidence interval [CI], 0.61-0.67) for immobilization, to almost perfect (0.98; 95% CI 0.97-0.99) for thrombophilia; risk classification was 0.64 (95% CI 0.60-0.67). Divergent risk classification occurred in 434 patients (18.2%) of whom seven (1.6%) developed VTE. Conclusion Despite substantial to almost perfect reliability between observers for risk factors and risk classification, lead clinicians tended to underestimate the risk for VTE.
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