Incidence and Patient Characteristics for the Development of Venous Thromboembolic Events within the Adult Burn Center Population and an Evaluation of the Caprini Risk Assessment Model
Michael J. Grzelak, BS, Vidhi Javia, BS, Carrie Cox, MS, RN, Mohammed Asif, MD, Scott Hultman, MD, FACS.
Johns Hopkins School of Medicine, Baltimore, MD, USA.
PURPOSE: Although the published incidence of venous thromboembolic events (VTEs) in burn patients is low (0.3% to 3.0%), VTEs can lead to fatal outcomes if not properly treated. While mechanical and chemoprophylaxis are commonly used to prevent VTEs, the medications carry a high risk of complications. As such, it is crucially important to identify characteristics that put burn patients at highest risk for VTE. One well known algorithm, the Caprini Risk Assessment Model, attempts to stratify surgery patients into low and high risk categories. Our aim in this study was to examine the sensitivity of the Caprini Model in our burn center patients as well as to elucidate some of the most common characteristics of these patients.
METHODS: We performed a retrospective analysis of the twelve patients who developed VTEs in our burn center between July 2013-July 2018. Patients were included if they suffered an acute VTE within the inpatient setting, and they were excluded if they had pre-existing VTEs or were non-burn patients. Pertinent medical histories and characteristics were obtained from patients' electronic medical records and were used to calculate VTE risk according to the Caprini Model. Measured outcomes included VTE history, predisposing genetic risk factors, cancer history, cardiopulmonary disease, use of VTE prophylaxis, total body surface area (TBSA) burn, and patient demographics.
RESULTS: Of the 2037 patients, twelve (0.59%) suffered a VTE. While the mean TBSA among all patients was 6.98% and mean length of stay was 7.74 days, the mean TBSA of the patients who suffered a VTE was 16% and mean length of stay was 39 days. According to the Caprini Model six patients (50%) were classified as "high risk" (1.8%-4.0% risk) and three (25%) were classified as "highest risk" (10.7% risk). Of the remaining patients, two (17%) were classified as "moderate risk" (0.7%) while one (8%) was classified as "low risk." We consider "moderate risk" and above to be a positive result, and therefore the sensitivity of the Caprini Model in our burn center is 92%. Interestingly, only six of the twelve patients received prophylaxis prior to their VTEs, and five of the six who did not receive prophylaxis were categorized as "high risk" or "highest risk" according to the Caprini Model.
CONCLUSION: In this retrospective analysis VTEs are shown to be highly correlated with increased TBSA as well as increased length of hospital stay. The Caprini Model was highly sensitive, and these results strongly support its use as a screening tool with in our burn center population.
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