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Anders Björkelund

Forskare

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Cohort study of prediction of venous thromboembolism in emergency department patients with extremity symptoms

Författare

  • Anders Gottsäter
  • Ulf Ekelund
  • Olle Melander
  • Anders Björkelund
  • Bodil Ohlsson

Summary, in English

Despite diagnostic algorithms, identification of venous thromboembolism (VTE) in emergency departments (ED) remains a challenge. We evaluated symptoms, background, and laboratory data in 27,647 ED patients presenting with pain, swelling, or other symptoms from the extremities, and identified predictors of VTE diagnosis within one year. Predictors of a clinical decision to perform phlebography, ultrasound, or computer tomography (CT) angiography of pelvic, lower, or upper extremity veins, CT of pulmonary arteries, or pulmonary scintigraphy at the ED or within 30 days, and the results of such investigations were also evaluated. A total of 3195 patients (11.6%) were diagnosed with VTE within one year. In adjusted analysis of patients in whom all laboratory data were available, a d-dimer value ≥ 0.5 mg/l (odds ratio [OR]: 2.602; 95% confidence interval [CI] 1.894–3.575; p < 0.001) at the ED and a previous diagnosis of VTE (OR: 6.037; CI 4.465–8.162; p < 0.001) independently predicted VTE within one year. Of diagnosed patients, 2355 (73.7%) had undergone imaging within 30 days after the ED visit and 1730 (54.1%) were diagnosed at this examination. Lower age (OR: 0.984; CI 0.972–0.997; p = 0.014), higher blood hemoglobin (OR: 1.023; CI 1.010–1.037; p < 0.001), C-reactive protein (OR: 2.229; CI 1.433–3.468; p < 0.001), d-dimer (OR: 8.729; CI 5.614–13.574; p < 0.001), and previous VTE (OR: 7.796; CI 5.193–11.705; p < 0.001) predicted VTE on imaging within 30 days, whereas female sex (OR 0.602 [95% CI 0.392–0.924]; p = 0.020) and a previous diagnosis of ischemic heart disease (OR 0.254 [95% CI 0.113–0.571]; p = 0.001) were negative predictors of VTE. In conclusion, analysis of 27,647 ED patients with extremity symptoms confirmed the importance of well-established risk factors for VTE. Many patients developing VTE within one year had initial negative imaging, highlighting the importance of continued symptom vigilance.

Avdelning/ar

  • Internmedicin - epidemiologi
  • EpiHealth: Epidemiology for Health
  • Medicin/akutsjukvård, Lund
  • Akutsjukvård
  • Kardiovaskulär forskning - hypertoni
  • EXODIAB: Excellence of Diabetes Research in Sweden
  • MultiPark: Multidisciplinary research focused on Parkinson's disease
  • Centrum för miljö- och klimatvetenskap (CEC)

Publiceringsår

2024

Språk

Engelska

Publikation/Tidskrift/Serie

Internal and Emergency Medicine

Dokumenttyp

Artikel i tidskrift

Förlag

Springer

Ämne

  • Cardiology and Cardiovascular Disease

Nyckelord

  • Deep vein thrombosis
  • Prediction
  • Pulmonary embolism
  • Venous thromboembolism

Aktiv

Epub

Projekt

  • AIR Lund - Artificially Intelligent use of Registers

Forskningsgrupp

  • Internal Medicine - Epidemiology
  • Emergency medicine
  • Cardiovascular Research - Hypertension

ISBN/ISSN/Övrigt

  • ISSN: 1828-0447