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The Michigan Risk Score to Predict Peripherally Inserted Central Catheter-Associated Thrombosis.
J Thromb Haemost. 2017 Aug 10;:
Authors: Chopra V, Kaatz S, Conlon A, Paje D, Grant PJ, Rogers MAM, Bernstein SJ, Saint S, Flanders SA
Abstract
BACKGROUND: Peripherally inserted central catheters (PICCs) are associated with upper extremity deep vein thrombosis (DVT). We developed a score to predict risk of PICC-related thrombosis.
METHODS: Using data from the Michigan Hospital Medicine Safety consortium, image-confirmed upper-extremity DVT cases were identified. A logistic, mixed effects model with hospital-specific random intercepts was used to identify factors associated with PICC-DVT. Points were assigned to each predictor, stratifying patients into four classes of risk. Internal validation was performed by bootstrapping with assessment of calibration and discrimination of the model.
RESULTS: Of 23,010 patients who received PICCs, 475 (2.1%) developed symptomatic PICC-DVT. Risk factors associated with PICC-DVT included: history of DVT; multi-lumen PICC; active cancer; presence of another CVC when the PICC was placed; and white blood cell count greater than 12,000. Thrombosis rates were 0.9% for class I, 1.6% for class II, 2.7% for class III and 4.7% for class IV, with marginal predicted probabilities of 0.9% (0.7, 1.2), 1.5% (1.2, 1.9), 2.6% (2.2, 3.0) and 4.5% (3.7, 5.4) for classes I, II, III, IV and V, respectively. The risk classification rule was associated with PICC-DVT, with odds ratios of 1.68 (95% CI: 1.19, 2.37), 2.90 (95% CI: 2.09, 4.01) and 5.20 (95% CI: 3.65, 7.42) for risk classes II, III and IV vs. risk class I, respectively.
CONCLUSION: The Michigan PICC-DVT Risk Score offers a novel way to estimate risk of DVT associated with PICCs and can help inform appropriateness of PICC insertion.
PMID: 28796444 [PubMed - as supplied by publisher]