The effect of obligatory Padua prediction scoring in hospitalized medically ill patients: A retrospective cohort study.

BackgroundVenous thromboembolism (VTE) is considered a preventable cause of mortality. The evidence for the benefit of VTE prophylaxis in acute medical patients is non-conclusive. Meta-analysis of RCTs failed to demonstrate reduction of all-cause mortality, while showing higher risk of bleeding. The Israeli Ministry of Health has instructed to assess all acute medical patients for the risk for VTE using the Padua Prediction Score, without mandating prophylaxis.AimTo evaluate the effect of filling the Padua score on clinical outcomes and VTE prophylaxis rates.MethodsRetrospective Study was performed in Israel during the years 2014-2017. The participants were divided to Padua compliance vs non-compliance group. Primary outcome: 30-day mortality. Secondary outcomes: 90-day incidence of VTE and suspected major bleeding. A propensity-weighted logistic multiple regression was performed.Results18,890 patients were included in the study. The fulfillment of the Padua score was associated with an increased use of VTE prophylaxis, OR 1.66 (95% CI 1.49-1.84). However, there was no reduction of mortality or VTE events, OR 1.13 (95% CI 0.97-1.31) and OR 1.22 (95% CI 0.79-1.8) respectively. Hospitalizations related to hemoglobin decrease were not statistically different between the two groups.ConclusionsPadua score for the assessment of VTE risk in medical wards was associated with higher administration of pharmacological prophylaxis without reduction in VTE or mortality rate. Its usage should be reassessed as a performance measure

Is warfarin usage a risk factor for osteoporotic fractures? A cohort study in the emergency department

Background Several studies have examined the association between warfarin sodium use and risk of osteoporotic fractures with conflicting results. Our study addresses this question, for the first time regarding patients attending emergency department (ED). Aims The aim of this study was to retrospectively detect whether there is higher rate of usage of warfarin sodium in patients with osteoporotic fractures attending an ED. Methods This is a retrospective study from patients' computerized charts. All individuals >65 years old who had an osteoporotic fracture and attended an ED in a tertiary hospital were compared with a similar group of elderly individuals >65 years old without an osteoporotic fracture who attended the ED for a cause other than an osteoporotic fracture. Results This study included 328 patients who were evaluated in the years 2005–2016. Overall, 164 individuals with a typical osteoporotic fracture (hip -66 patients (40 per cent), spine- 92 patients (56 per cent), humerus -4 patients (2 per cent), radius -13 patients (8 per cent)) were identified and compared with a matched group of elderly individuals who were evaluated in the ED for other complaints. Warfarin sodium was used in 61 individuals (19 per cent) in the entire cohort, 34 in the fracture group and 27 in the non-fracture group (p=0.324). Conclusion In elderly patients, attending an ED, warfarin sodium use does not seem to be a risk factor for an osteoporotic fractur

ICD 9 codes in the study.

BackgroundVenous thromboembolism (VTE) is considered a preventable cause of mortality. The evidence for the benefit of VTE prophylaxis in acute medical patients is non-conclusive. Meta-analysis of RCTs failed to demonstrate reduction of all-cause mortality, while showing higher risk of bleeding. The Israeli Ministry of Health has instructed to assess all acute medical patients for the risk for VTE using the Padua Prediction Score, without mandating prophylaxis.AimTo evaluate the effect of filling the Padua score on clinical outcomes and VTE prophylaxis rates.MethodsRetrospective Study was performed in Israel during the years 2014–2017. The participants were divided to Padua compliance vs non-compliance group. Primary outcome: 30-day mortality. Secondary outcomes: 90-day incidence of VTE and suspected major bleeding. A propensity-weighted logistic multiple regression was performed.Results18,890 patients were included in the study. The fulfillment of the Padua score was associated with an increased use of VTE prophylaxis, OR 1.66 (95% CI 1.49–1.84). However, there was no reduction of mortality or VTE events, OR 1.13 (95% CI 0.97–1.31) and OR 1.22 (95% CI 0.79–1.8) respectively. Hospitalizations related to hemoglobin decrease were not statistically different between the two groups.ConclusionsPadua score for the assessment of VTE risk in medical wards was associated with higher administration of pharmacological prophylaxis without reduction in VTE or mortality rate. Its usage should be reassessed as a performance measure.</div

Padua score.

BackgroundVenous thromboembolism (VTE) is considered a preventable cause of mortality. The evidence for the benefit of VTE prophylaxis in acute medical patients is non-conclusive. Meta-analysis of RCTs failed to demonstrate reduction of all-cause mortality, while showing higher risk of bleeding. The Israeli Ministry of Health has instructed to assess all acute medical patients for the risk for VTE using the Padua Prediction Score, without mandating prophylaxis.AimTo evaluate the effect of filling the Padua score on clinical outcomes and VTE prophylaxis rates.MethodsRetrospective Study was performed in Israel during the years 2014–2017. The participants were divided to Padua compliance vs non-compliance group. Primary outcome: 30-day mortality. Secondary outcomes: 90-day incidence of VTE and suspected major bleeding. A propensity-weighted logistic multiple regression was performed.Results18,890 patients were included in the study. The fulfillment of the Padua score was associated with an increased use of VTE prophylaxis, OR 1.66 (95% CI 1.49–1.84). However, there was no reduction of mortality or VTE events, OR 1.13 (95% CI 0.97–1.31) and OR 1.22 (95% CI 0.79–1.8) respectively. Hospitalizations related to hemoglobin decrease were not statistically different between the two groups.ConclusionsPadua score for the assessment of VTE risk in medical wards was associated with higher administration of pharmacological prophylaxis without reduction in VTE or mortality rate. Its usage should be reassessed as a performance measure.</div

ROC (receiver operating characteristic) curve for the physician filled Padua score vs the calculated Padua score (CPPS).

ROC (receiver operating characteristic) curve for the physician filled Padua score vs the calculated Padua score (CPPS).</p

Outcomes according to filling of the Padua score.

BackgroundVenous thromboembolism (VTE) is considered a preventable cause of mortality. The evidence for the benefit of VTE prophylaxis in acute medical patients is non-conclusive. Meta-analysis of RCTs failed to demonstrate reduction of all-cause mortality, while showing higher risk of bleeding. The Israeli Ministry of Health has instructed to assess all acute medical patients for the risk for VTE using the Padua Prediction Score, without mandating prophylaxis.AimTo evaluate the effect of filling the Padua score on clinical outcomes and VTE prophylaxis rates.MethodsRetrospective Study was performed in Israel during the years 2014–2017. The participants were divided to Padua compliance vs non-compliance group. Primary outcome: 30-day mortality. Secondary outcomes: 90-day incidence of VTE and suspected major bleeding. A propensity-weighted logistic multiple regression was performed.Results18,890 patients were included in the study. The fulfillment of the Padua score was associated with an increased use of VTE prophylaxis, OR 1.66 (95% CI 1.49–1.84). However, there was no reduction of mortality or VTE events, OR 1.13 (95% CI 0.97–1.31) and OR 1.22 (95% CI 0.79–1.8) respectively. Hospitalizations related to hemoglobin decrease were not statistically different between the two groups.ConclusionsPadua score for the assessment of VTE risk in medical wards was associated with higher administration of pharmacological prophylaxis without reduction in VTE or mortality rate. Its usage should be reassessed as a performance measure.</div

Multiregression analysis for mortality.

BackgroundVenous thromboembolism (VTE) is considered a preventable cause of mortality. The evidence for the benefit of VTE prophylaxis in acute medical patients is non-conclusive. Meta-analysis of RCTs failed to demonstrate reduction of all-cause mortality, while showing higher risk of bleeding. The Israeli Ministry of Health has instructed to assess all acute medical patients for the risk for VTE using the Padua Prediction Score, without mandating prophylaxis.AimTo evaluate the effect of filling the Padua score on clinical outcomes and VTE prophylaxis rates.MethodsRetrospective Study was performed in Israel during the years 2014–2017. The participants were divided to Padua compliance vs non-compliance group. Primary outcome: 30-day mortality. Secondary outcomes: 90-day incidence of VTE and suspected major bleeding. A propensity-weighted logistic multiple regression was performed.Results18,890 patients were included in the study. The fulfillment of the Padua score was associated with an increased use of VTE prophylaxis, OR 1.66 (95% CI 1.49–1.84). However, there was no reduction of mortality or VTE events, OR 1.13 (95% CI 0.97–1.31) and OR 1.22 (95% CI 0.79–1.8) respectively. Hospitalizations related to hemoglobin decrease were not statistically different between the two groups.ConclusionsPadua score for the assessment of VTE risk in medical wards was associated with higher administration of pharmacological prophylaxis without reduction in VTE or mortality rate. Its usage should be reassessed as a performance measure.</div

Patients’ characteristics according to physician’s compliance with filling the Padua score.

Patients’ characteristics according to physician’s compliance with filling the Padua score.</p

Administration of VTE prophylaxis according to fulfillment of Padua score.

Administration of VTE prophylaxis according to fulfillment of Padua score.</p