Initial mobility assessment in VTE risk stratification lacks accuracy

Initial clinical mobility assessments during venous thromboembolism (VTE) risk evaluation do not seem to convey patient mobility during their hospital stay, reveals a study. 

A team of investigators performed this retrospective study at a quaternary academic hospital and examined patients using the Padua risk tool, which includes a mobility question, and the Johns Hopkins-Highest Level of Mobility (JH-HLM) scores to measure mobility objectively. Reduced mobility was characterized by JH-HLM scores ≤3 for 3 or more consecutive days. 

Using multivariable logistic regression, the investigators explored the relationship between reduced mobility and hospital-acquired VTE, comparing admitting healthcare professional assessments with JH-HLM scores. Treating providers radiographically diagnosed symptomatic, hospital-acquired thromboembolisms. 

A total of 1,715 patients were examined. Of these, 33 (1.9 percent) developed VTE. Reduced mobility was found to be significantly associated with thromboembolic events (adjusted odds ratio, 2.53, 95 percent confidence interval, 1.23−5.22; p=0.012). However, the initial Padua assessment of expected reduced mobility was not. 

Using the JH-HLM score, 19.1 percent of patients were found to have reduced mobility as compared with 6.5 percent by admitting healthcare professionals. This showed that 37 high-risk patients were misclassified as low-risk and did not receive prescriptions for thrombosis prophylaxis. In addition, four patients developed thromboembolic events. 

Furthermore, JH-HLM identified reduced mobility in 36 percent of thromboembolic cases as opposed to only 9 percent by admitting healthcare professionals. 

"This highlights the need for objective measures like JH-HLM in risk assessments to improve accuracy and potentially reduce thromboembolism incidents,” the investigators said.