Predictive and Associative Models to Identify Hospitalized Medical Patients at Risk for VTE
Identifieur interne : 006809 ( Main/Exploration ); précédent : 006808; suivant : 006810Predictive and Associative Models to Identify Hospitalized Medical Patients at Risk for VTE
Auteurs : Alex C. Spyropoulos [Canada] ; Frederick A. Jr Anderson [Canada] ; Gordon Fitzgerald [Canada] ; Herve Decousus [France] ; Mario Pini [Italie] ; Beng H. Chong [Australie] ; Rainer B. Zotz [Allemagne] ; Jean-François Bergmann [France] ; Victor Tapson [États-Unis] ; James B. Froehlich [États-Unis] ; Manuel Monreal [Espagne] ; Geno J. Merli [États-Unis] ; Ricardo Pavanello [Brésil] ; Alexander G. G. Turpie [Canada] ; Mashio Nakamura [Japon] ; Franco Piovella [Italie] ; Ajay K. Kakkar [Royaume-Uni] ; Frederick A. Spencer [Canada]Source :
- Chest : (American College of Chest Physicians) [ 0012-3692 ] ; 2011.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Hospitalisation, Homme.
English descriptors
- KwdEn :
Abstract
Background: Acutely ill hospitalized medical patients are at risk for VTE. We assessed the incidence of VTE in the observational International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) study and derived VTE risk assessment scores at admission and associative VTE scores during hospitalization. Methods: Data from 15,156 medical patients were analyzed to determine the cumulative incidence of clinically observed VTE over 3 months after admission. Multiple regression analysis identified factors associated with VTE risk. Results: Of the 184 patients who developed symptomatic VTE, 76 had pulmonary embolism, and 67 had lower-extremity DVT. Cumulative VTE incidence was 1.0%; 45% of events occurred after discharge. Factors independently associated with VTE were previous VTE, known thrombophilia, cancer, age > 60 years, lower-limb paralysis, immobilization ≥ 7 days, and admission to an ICU or coronary care unit (first four were available at admission). Points were assigned to each factor identified to give a total risk score for each patient. At admission, 67% of patients had a score ≥ 1. During hospitalization, 31% had a score ≥2; for a score of 2 or 3, observed VTE risk was 1.5% vs 5.7% for a score ≥4. Observed and predicted rates were similar for both models (C statistic, 0.65 and 0.69, respectively). During hospitalization, a score ≥2 was associated with higher overall and VTE-related mortality. Conclusions: Weighted VTE risk scores derived from four clinical risk factors at hospital admission can predict VTE risk in acutely ill hospitalized medical patients. Scores derived from seven clinical factors during hospitalization may help us to further understand symptomatic VTE risk. These scores require external validation.
Affiliations:
- Allemagne, Australie, Brésil, Canada, Espagne, France, Italie, Japon, Royaume-Uni, États-Unis
- Angleterre, Auvergne-Rhône-Alpes, District de Düsseldorf, Grand Londres, Ontario, Rhénanie-du-Nord-Westphalie, Rhône-Alpes, État de São Paulo, Île-de-France
- Düsseldorf, Hamilton (Ontario), Londres, Paris, Saint-Étienne, São Paulo
- University College de Londres, Université McMaster
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Chong</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>St. George Clinical School University of New South Wales</s1><s2>Sydney, NSW</s2><s3>AUS</s3><sZ>6 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>St. George Clinical School University of New South Wales</wicri:noRegion></affiliation></author><author><name sortKey="Zotz, Rainer B" sort="Zotz, Rainer B" uniqKey="Zotz R" first="Rainer B." last="Zotz">Rainer B. Zotz</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Hämostase-Institut Diisseldorf</s1><s2>Dusseldorf</s2><s3>DEU</s3><sZ>7 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Rhénanie-du-Nord-Westphalie</region><region type="district" nuts="2">District de Düsseldorf</region><settlement type="city">Düsseldorf</settlement></placeName></affiliation></author><author><name sortKey="Bergmann, Jean Francois" sort="Bergmann, Jean Francois" uniqKey="Bergmann J" first="Jean-François" last="Bergmann">Jean-François Bergmann</name><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Hopital Lariboisiere Clinique Thérapeutique University Paris Diderot</s1><s2>Paris</s2><s3>FRA</s3><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Tapson, Victor" sort="Tapson, Victor" uniqKey="Tapson V" first="Victor" last="Tapson">Victor Tapson</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Duke University Medical Center</s1><s2>Durham, NC</s2><s3>USA</s3><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Duke University Medical Center</wicri:noRegion></affiliation></author><author><name sortKey="Froehlich, James B" sort="Froehlich, James B" uniqKey="Froehlich J" first="James B." last="Froehlich">James B. Froehlich</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Vascular Medicine University of Michigan Health System</s1><s2>Ann Arbor, MI</s2><s3>USA</s3><sZ>10 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Vascular Medicine University of Michigan Health System</wicri:noRegion></affiliation></author><author><name sortKey="Monreal, Manuel" sort="Monreal, Manuel" uniqKey="Monreal M" first="Manuel" last="Monreal">Manuel Monreal</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Servicio de Medicina Interna Hospital Germans Trias i Pujol</s1><s2>Badalona</s2><s3>ESP</s3><sZ>11 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Servicio de Medicina Interna Hospital Germans Trias i Pujol</wicri:noRegion></affiliation></author><author><name sortKey="Merli, Geno J" sort="Merli, Geno J" uniqKey="Merli G" first="Geno J." last="Merli">Geno J. Merli</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>Jefferson Vascular Diseases Center Departments of Surgery and Medicine, Thomas Jefferson University Hospital</s1><s2>Philadelphia, PA</s2><s3>USA</s3><sZ>12 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Philadelphia, PA</wicri:noRegion></affiliation></author><author><name sortKey="Pavanello, Ricardo" sort="Pavanello, Ricardo" uniqKey="Pavanello R" first="Ricardo" last="Pavanello">Ricardo Pavanello</name><affiliation wicri:level="3"><inist:fA14 i1="13"><s1>Hospital do Coracao Clinica Medica São Paulo</s1><s2>Sao Paulo</s2><s3>BRA</s3><sZ>13 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Turpie, Alexander G G" sort="Turpie, Alexander G G" uniqKey="Turpie A" first="Alexander G. G." last="Turpie">Alexander G. G. Turpie</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Hamilton Health Sciences General Hospital , McMaster University</s1><s2>Hamilton, ON</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université McMaster</orgName></affiliation></author><author><name sortKey="Nakamura, Mashio" sort="Nakamura, Mashio" uniqKey="Nakamura M" first="Mashio" last="Nakamura">Mashio Nakamura</name><affiliation wicri:level="1"><inist:fA14 i1="14"><s1>Department of Cardiology Mie University Graduate School of Medicine</s1><s2>Tsu Mie</s2><s3>JPN</s3><sZ>15 aut.</sZ></inist:fA14><country>Japon</country><wicri:noRegion>Department of Cardiology Mie University Graduate School of Medicine</wicri:noRegion></affiliation></author><author><name sortKey="Piovella, Franco" sort="Piovella, Franco" uniqKey="Piovella F" first="Franco" last="Piovella">Franco Piovella</name><affiliation wicri:level="1"><inist:fA14 i1="15"><s1>U.O. Angiologia Fondazione IRCCS Policlinico San Matteo</s1><s2>Pavia</s2><s3>ITA</s3><sZ>16 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>U.O. Angiologia Fondazione IRCCS Policlinico San Matteo</wicri:noRegion></affiliation></author><author><name sortKey="Kakkar, Ajay K" sort="Kakkar, Ajay K" uniqKey="Kakkar A" first="Ajay K." last="Kakkar">Ajay K. Kakkar</name><affiliation wicri:level="4"><inist:fA14 i1="16"><s1>Thrombosis Research Institute and University College London</s1><s2>London</s2><s3>GBR</s3><sZ>17 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region><settlement type="city">Londres</settlement></placeName><orgName type="university">University College de Londres</orgName></affiliation></author><author><name sortKey="Spencer, Frederick A" sort="Spencer, Frederick A" uniqKey="Spencer F" first="Frederick A." last="Spencer">Frederick A. Spencer</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Hamilton Health Sciences McMaster University</s1><s2>Hamilton, ON</s2><s3>CAN</s3><sZ>18 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton Health Sciences McMaster University</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">11-0424166</idno><date when="2011">2011</date><idno type="stanalyst">PASCAL 11-0424166 INIST</idno><idno type="RBID">Pascal:11-0424166</idno><idno type="wicri:Area/PascalFrancis/Corpus">001937</idno><idno type="wicri:Area/PascalFrancis/Curation">004619</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">001767</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">001767</idno><idno type="wicri:doubleKey">0012-3692:2011:Spyropoulos A:predictive:and:associative</idno><idno type="wicri:Area/Main/Merge">006C18</idno><idno type="wicri:Area/Main/Curation">006809</idno><idno type="wicri:Area/Main/Exploration">006809</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Predictive and Associative Models to Identify Hospitalized Medical Patients at Risk for VTE</title><author><name sortKey="Spyropoulos, Alex C" sort="Spyropoulos, Alex C" uniqKey="Spyropoulos A" first="Alex C." last="Spyropoulos">Alex C. Spyropoulos</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Hamilton Health Sciences General Hospital , McMaster University</s1><s2>Hamilton, ON</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université McMaster</orgName></affiliation></author><author><name sortKey="Anderson, Frederick A Jr" sort="Anderson, Frederick A Jr" uniqKey="Anderson F" first="Frederick A. Jr" last="Anderson">Frederick A. Jr Anderson</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Center for Outcomes Research University of Massachusetts Medical School</s1><s2>Worcester, MA</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Center for Outcomes Research University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Fitzgerald, Gordon" sort="Fitzgerald, Gordon" uniqKey="Fitzgerald G" first="Gordon" last="Fitzgerald">Gordon Fitzgerald</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Center for Outcomes Research University of Massachusetts Medical School</s1><s2>Worcester, MA</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Center for Outcomes Research University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Decousus, Herve" sort="Decousus, Herve" uniqKey="Decousus H" first="Herve" last="Decousus">Herve Decousus</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>INSERM, CIE3, Saint-Etienne University Saint-Etienne, and CHU Saint-Etienne, Hopital Nord, Service de Médecine Interne et Therapeutique</s1><s2>Saint-Etienne</s2><s3>FRA</s3><sZ>4 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Saint-Étienne</settlement></placeName></affiliation></author><author><name sortKey="Pini, Mario" sort="Pini, Mario" uniqKey="Pini M" first="Mario" last="Pini">Mario Pini</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Medicina Interna II Fidenza Hospital</s1><s2>Parma</s2><s3>ITA</s3><sZ>5 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Medicina Interna II Fidenza Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Chong, Beng H" sort="Chong, Beng H" uniqKey="Chong B" first="Beng H." last="Chong">Beng H. Chong</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>St. George Clinical School University of New South Wales</s1><s2>Sydney, NSW</s2><s3>AUS</s3><sZ>6 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>St. George Clinical School University of New South Wales</wicri:noRegion></affiliation></author><author><name sortKey="Zotz, Rainer B" sort="Zotz, Rainer B" uniqKey="Zotz R" first="Rainer B." last="Zotz">Rainer B. Zotz</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Hämostase-Institut Diisseldorf</s1><s2>Dusseldorf</s2><s3>DEU</s3><sZ>7 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Rhénanie-du-Nord-Westphalie</region><region type="district" nuts="2">District de Düsseldorf</region><settlement type="city">Düsseldorf</settlement></placeName></affiliation></author><author><name sortKey="Bergmann, Jean Francois" sort="Bergmann, Jean Francois" uniqKey="Bergmann J" first="Jean-François" last="Bergmann">Jean-François Bergmann</name><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Hopital Lariboisiere Clinique Thérapeutique University Paris Diderot</s1><s2>Paris</s2><s3>FRA</s3><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Tapson, Victor" sort="Tapson, Victor" uniqKey="Tapson V" first="Victor" last="Tapson">Victor Tapson</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Duke University Medical Center</s1><s2>Durham, NC</s2><s3>USA</s3><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Duke University Medical Center</wicri:noRegion></affiliation></author><author><name sortKey="Froehlich, James B" sort="Froehlich, James B" uniqKey="Froehlich J" first="James B." last="Froehlich">James B. Froehlich</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Vascular Medicine University of Michigan Health System</s1><s2>Ann Arbor, MI</s2><s3>USA</s3><sZ>10 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Vascular Medicine University of Michigan Health System</wicri:noRegion></affiliation></author><author><name sortKey="Monreal, Manuel" sort="Monreal, Manuel" uniqKey="Monreal M" first="Manuel" last="Monreal">Manuel Monreal</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Servicio de Medicina Interna Hospital Germans Trias i Pujol</s1><s2>Badalona</s2><s3>ESP</s3><sZ>11 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Servicio de Medicina Interna Hospital Germans Trias i Pujol</wicri:noRegion></affiliation></author><author><name sortKey="Merli, Geno J" sort="Merli, Geno J" uniqKey="Merli G" first="Geno J." last="Merli">Geno J. Merli</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>Jefferson Vascular Diseases Center Departments of Surgery and Medicine, Thomas Jefferson University Hospital</s1><s2>Philadelphia, PA</s2><s3>USA</s3><sZ>12 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Philadelphia, PA</wicri:noRegion></affiliation></author><author><name sortKey="Pavanello, Ricardo" sort="Pavanello, Ricardo" uniqKey="Pavanello R" first="Ricardo" last="Pavanello">Ricardo Pavanello</name><affiliation wicri:level="3"><inist:fA14 i1="13"><s1>Hospital do Coracao Clinica Medica São Paulo</s1><s2>Sao Paulo</s2><s3>BRA</s3><sZ>13 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Turpie, Alexander G G" sort="Turpie, Alexander G G" uniqKey="Turpie A" first="Alexander G. G." last="Turpie">Alexander G. G. Turpie</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Hamilton Health Sciences General Hospital , McMaster University</s1><s2>Hamilton, ON</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université McMaster</orgName></affiliation></author><author><name sortKey="Nakamura, Mashio" sort="Nakamura, Mashio" uniqKey="Nakamura M" first="Mashio" last="Nakamura">Mashio Nakamura</name><affiliation wicri:level="1"><inist:fA14 i1="14"><s1>Department of Cardiology Mie University Graduate School of Medicine</s1><s2>Tsu Mie</s2><s3>JPN</s3><sZ>15 aut.</sZ></inist:fA14><country>Japon</country><wicri:noRegion>Department of Cardiology Mie University Graduate School of Medicine</wicri:noRegion></affiliation></author><author><name sortKey="Piovella, Franco" sort="Piovella, Franco" uniqKey="Piovella F" first="Franco" last="Piovella">Franco Piovella</name><affiliation wicri:level="1"><inist:fA14 i1="15"><s1>U.O. Angiologia Fondazione IRCCS Policlinico San Matteo</s1><s2>Pavia</s2><s3>ITA</s3><sZ>16 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>U.O. Angiologia Fondazione IRCCS Policlinico San Matteo</wicri:noRegion></affiliation></author><author><name sortKey="Kakkar, Ajay K" sort="Kakkar, Ajay K" uniqKey="Kakkar A" first="Ajay K." last="Kakkar">Ajay K. Kakkar</name><affiliation wicri:level="4"><inist:fA14 i1="16"><s1>Thrombosis Research Institute and University College London</s1><s2>London</s2><s3>GBR</s3><sZ>17 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region><settlement type="city">Londres</settlement></placeName><orgName type="university">University College de Londres</orgName></affiliation></author><author><name sortKey="Spencer, Frederick A" sort="Spencer, Frederick A" uniqKey="Spencer F" first="Frederick A." last="Spencer">Frederick A. Spencer</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Hamilton Health Sciences McMaster University</s1><s2>Hamilton, ON</s2><s3>CAN</s3><sZ>18 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton Health Sciences McMaster University</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Chest : (American College of Chest Physicians)</title><title level="j" type="abbreviated">Chest : (Amer. Coll. Chest Phys.)</title><idno type="ISSN">0012-3692</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Chest : (American College of Chest Physicians)</title><title level="j" type="abbreviated">Chest : (Amer. Coll. Chest Phys.)</title><idno type="ISSN">0012-3692</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Anesthesia</term><term>Cardiology</term><term>Circulatory system</term><term>Hospitalization</term><term>Human</term><term>Models</term><term>Patient</term><term>Predictive factor</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Facteur prédictif</term><term>Modèle</term><term>Hospitalisation</term><term>Homme</term><term>Malade</term><term>Anesthésie</term><term>Appareil circulatoire</term><term>Cardiologie</term><term>Comportement à risque</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Hospitalisation</term><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: Acutely ill hospitalized medical patients are at risk for VTE. We assessed the incidence of VTE in the observational International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) study and derived VTE risk assessment scores at admission and associative VTE scores during hospitalization. Methods: Data from 15,156 medical patients were analyzed to determine the cumulative incidence of clinically observed VTE over 3 months after admission. Multiple regression analysis identified factors associated with VTE risk. Results: Of the 184 patients who developed symptomatic VTE, 76 had pulmonary embolism, and 67 had lower-extremity DVT. Cumulative VTE incidence was 1.0%; 45% of events occurred after discharge. Factors independently associated with VTE were previous VTE, known thrombophilia, cancer, age > 60 years, lower-limb paralysis, immobilization ≥ 7 days, and admission to an ICU or coronary care unit (first four were available at admission). Points were assigned to each factor identified to give a total risk score for each patient. At admission, 67% of patients had a score ≥ 1. During hospitalization, 31% had a score ≥2; for a score of 2 or 3, observed VTE risk was 1.5% vs 5.7% for a score ≥4. Observed and predicted rates were similar for both models (C statistic, 0.65 and 0.69, respectively). During hospitalization, a score ≥2 was associated with higher overall and VTE-related mortality. Conclusions: Weighted VTE risk scores derived from four clinical risk factors at hospital admission can predict VTE risk in acutely ill hospitalized medical patients. Scores derived from seven clinical factors during hospitalization may help us to further understand symptomatic VTE risk. These scores require external validation.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>Brésil</li><li>Canada</li><li>Espagne</li><li>France</li><li>Italie</li><li>Japon</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Auvergne-Rhône-Alpes</li><li>District de Düsseldorf</li><li>Grand Londres</li><li>Ontario</li><li>Rhénanie-du-Nord-Westphalie</li><li>Rhône-Alpes</li><li>État de São Paulo</li><li>Île-de-France</li></region><settlement><li>Düsseldorf</li><li>Hamilton (Ontario)</li><li>Londres</li><li>Paris</li><li>Saint-Étienne</li><li>São Paulo</li></settlement><orgName><li>University College de Londres</li><li>Université McMaster</li></orgName></list><tree><country name="Canada"><region name="Ontario"><name sortKey="Spyropoulos, Alex C" sort="Spyropoulos, Alex C" uniqKey="Spyropoulos A" first="Alex C." last="Spyropoulos">Alex C. Spyropoulos</name></region><name sortKey="Anderson, Frederick A Jr" sort="Anderson, Frederick A Jr" uniqKey="Anderson F" first="Frederick A. Jr" last="Anderson">Frederick A. Jr Anderson</name><name sortKey="Fitzgerald, Gordon" sort="Fitzgerald, Gordon" uniqKey="Fitzgerald G" first="Gordon" last="Fitzgerald">Gordon Fitzgerald</name><name sortKey="Spencer, Frederick A" sort="Spencer, Frederick A" uniqKey="Spencer F" first="Frederick A." last="Spencer">Frederick A. Spencer</name><name sortKey="Turpie, Alexander G G" sort="Turpie, Alexander G G" uniqKey="Turpie A" first="Alexander G. G." last="Turpie">Alexander G. G. Turpie</name></country><country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Decousus, Herve" sort="Decousus, Herve" uniqKey="Decousus H" first="Herve" last="Decousus">Herve Decousus</name></region><name sortKey="Bergmann, Jean Francois" sort="Bergmann, Jean Francois" uniqKey="Bergmann J" first="Jean-François" last="Bergmann">Jean-François Bergmann</name></country><country name="Italie"><noRegion><name sortKey="Pini, Mario" sort="Pini, Mario" uniqKey="Pini M" first="Mario" last="Pini">Mario Pini</name></noRegion><name sortKey="Piovella, Franco" sort="Piovella, Franco" uniqKey="Piovella F" first="Franco" last="Piovella">Franco Piovella</name></country><country name="Australie"><noRegion><name sortKey="Chong, Beng H" sort="Chong, Beng H" uniqKey="Chong B" first="Beng H." last="Chong">Beng H. Chong</name></noRegion></country><country name="Allemagne"><region name="Rhénanie-du-Nord-Westphalie"><name sortKey="Zotz, Rainer B" sort="Zotz, Rainer B" uniqKey="Zotz R" first="Rainer B." last="Zotz">Rainer B. Zotz</name></region></country><country name="États-Unis"><noRegion><name sortKey="Tapson, Victor" sort="Tapson, Victor" uniqKey="Tapson V" first="Victor" last="Tapson">Victor Tapson</name></noRegion><name sortKey="Froehlich, James B" sort="Froehlich, James B" uniqKey="Froehlich J" first="James B." last="Froehlich">James B. Froehlich</name><name sortKey="Merli, Geno J" sort="Merli, Geno J" uniqKey="Merli G" first="Geno J." last="Merli">Geno J. Merli</name></country><country name="Espagne"><noRegion><name sortKey="Monreal, Manuel" sort="Monreal, Manuel" uniqKey="Monreal M" first="Manuel" last="Monreal">Manuel Monreal</name></noRegion></country><country name="Brésil"><region name="État de São Paulo"><name sortKey="Pavanello, Ricardo" sort="Pavanello, Ricardo" uniqKey="Pavanello R" first="Ricardo" last="Pavanello">Ricardo Pavanello</name></region></country><country name="Japon"><noRegion><name sortKey="Nakamura, Mashio" sort="Nakamura, Mashio" uniqKey="Nakamura M" first="Mashio" last="Nakamura">Mashio Nakamura</name></noRegion></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Kakkar, Ajay K" sort="Kakkar, Ajay K" uniqKey="Kakkar A" first="Ajay K." last="Kakkar">Ajay K. Kakkar</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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