A Prospective Cohort Study of the Epidemiology of Symptomatic Venous Thromboembolism (VTE) after Isolated Leg Fractures Distal to the Knee without Thromboprophylaxis.
Notice bibliographique
Résumé
Abstract We report final results from the first, large, multicenter, prospective cohort study designed to define the incidence of symptomatic venous thromboembolism (VTE) in patients with isolated leg fractures below the knee, and determine if routine thromboprophylaxis will be cost-effective. The reported incidence of deep vein thrombosis (DVT) using screening venography in such patients is as high as 40%. This has lead to the use of routine anticoagulant prophylaxis for several weeks in many such patients. However the vast majority of venographically-detected DVTs are asymptomatic, distal thrombi, whose clinical relevance is uncertain. Therefore venography may not be the best outcome measure to assess the clinical burden of clinically-important VTE, or as an endpoint for trials of thromboprophylaxis. Methods: From August 2002 to June 2005, 2446 consecutive patients with fractures of the patella, fibula and foot (treated operatively or conservatively) and tibial fractures (treated non operatively) were assessed at 5 hospitals in Ontario, Canada. Patients were enrolled after informed consent within 96 hours of the injury. Patients with major trauma, active cancer, and previous VTE were excluded. Thromboprophylaxis was not allowed. Patients were followed prospectively for 3 months, with telephone calls at 14 days, 6 weeks and 3 months. Education regarding symptoms of DVT and pulmonary embolism (PE) was provided at study entry and patients were asked about VTE symptoms at follow up. Suspected DVT and PE were investigated in a standardized manner. Results: 1200 patients have been enrolled and 1174 have completed 3-month follow up at this time. The last patient will complete follow up by the end of September 2005. The mean age of this cohort was 45 years (range 16 to 93) and 60% were female. Most injuries were caused by falls (56 %), followed by vehicular accidents (25 %), sports injuries (16 %), and occupational injuries (3 %). 18 % of patients had other minor injuries. 99 % of these fractures were unilateral. Fractures of the fibula were the commonest (39 %), followed by metatarsal (30 %), phalanges (12 %), calcaneus, talus or tarsal (10 %), tibia (10 %) and patella (5 %). 7 % of fractures were surgically treated. 82% of patients received a cast or splint for a mean duration of 42 ± 35 days. Six patients (0.5%) received anticoagulant prophylaxis (outside study protocol) at some time within the study period. Complete follow up was available for 98 % of this cohort. 21 patients either withdrew consent for follow up, or could not be contacted despite numerous attempts. By 3 months, only 7 of 1174 patients had sustained a symptomatic, objectively-confirmed VTE (2 proximal DVT, 3 calf DVT, 2 PE) with no fatal PE - an incidence of 0.6 % (95% C.I. 0.2 to 1.2). Conclusions: Based on a large prospective cohort of patients with leg fractures below the knee with no prophylaxis use, and 98% follow-up, we observed no fatal PE, and only 0.6% symptomatic VTE, confirming that routine thromboprophylaxis is not warranted, and not likely to be cost-effective in these patients. Furthermore symptomatic VTE is so uncommon, that it is unlikely that any high-risk subgroups can be identified for targeted prophylaxis. This study also highlights the significant discrepancy in the incidence of VTE between studies using venography and those utilizing clinical endpoints.
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Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».