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AHRQ Research Studies Date
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- Adverse Events (3)
- (-) Blood Clots (13)
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- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Clinical Decision Support (CDS) (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 13 of 13 Research Studies DisplayedPannucci CJ, Fleming KI, Varghese TK
Low anti-factor Xa level predicts 90-day symptomatic venous thromboembolism in surgical patients receiving enoxaparin prophylaxis: a pooled analysis of eight clinical trials.
This study examined whether low anti-factor Xa (aFXa) level predicts 90-day symptomatic venous thromboembolism (VTE) in surgical patients receiving enoxaparin prophylaxis. The authors conducted a pooled analysis of 8 clinical trials from a single institution over a 4-year period. Among 985 patients, 2.3% had symptomatic 90-day VTE, 4.2% had 90-day clinically relevant bleeding, and 2.1% had major bleeding. Patients with initial low aFXa were significantly more likely to have 90-day VTE than patients with adequate or high xFXa (4.2% vs 1.3%). This relationship was significant for patients who received enoxaparin twice daily as opposed to once a day. No association was seen between high xFXa and 90-day clinically relevant bleeding or major bleeding.
AHRQ-funded; HS024326.
Citation: Pannucci CJ, Fleming KI, Varghese TK .
Low anti-factor Xa level predicts 90-day symptomatic venous thromboembolism in surgical patients receiving enoxaparin prophylaxis: a pooled analysis of eight clinical trials.
Ann Surg 2022 Dec 1;276(6):e682-e90. doi: 10.1097/sla.0000000000004589..
Keywords: Blood Thinners, Surgery, Medication, Blood Clots
Weekes AJ, Raper JD, Thomas AM
Electrocardiographic findings associated with early clinical deterioration in acute pulmonary embolism.
Investigators sought to determine associations of early ECG patterns with clinical deterioration (CD) within 5 days and with RV abnormality (abnlRV) by echocardiography in PE. They found that supraventricular tachycardia was an independent predictor of CD, while T-wave inversion, incomplete right bundle branch block, ST-segment elevation aVR, sinus tachycardia, and S1-Q3-T3 were independent predictors of abnlRV. They suggested that finding one or more of these ECG patterns may increase considerations for performance of echocardiography to look for RV abnormalities and, if present, inform concerns for early clinical deterioration.
AHRQ-funded; HS025979.
Citation: Weekes AJ, Raper JD, Thomas AM .
Electrocardiographic findings associated with early clinical deterioration in acute pulmonary embolism.
Acad Emerg Med 2022 Oct;29(10):1185-96. doi: 10.1111/acem.14554..
Keywords: Respiratory Conditions, Blood Clots
Lee PT, Krecko LK, Savage S
Which hospital-acquired conditions matter the most in trauma? An evidence-based approach for prioritizing trauma program improvement.
The purpose of this study was to quantify and compare the impacts of six different hospital-acquired conditions (HACs) on early clinical outcomes and resource utilization in hospitalized trauma patients. The researchers included 529,856 adult patients from the 2013 to 2016 American College of Surgeons Trauma Quality Improvement Program Participant Use Data Files with 5 days or longer of hospitalization and had an Injury Severity Score of 9 or higher. The study found the incidences of HACs were: pneumonia, 5.2%; urinary tract infection, 3.4%; venous thromboembolism, 3.3%; surgical site infection, 1.3%; pressure ulcer, 1.3%; and central line-associated blood stream infection, 0.2%. The HAC of pneumonia demonstrated the largest association with in-hospital outcomes and resource utilization. The researchers reported that prevention of pneumonia within the study group would have resulted in estimated reductions of: 22.1% for end organ dysfunction, 8.7% for prolonged hospitalization, 7.8% for mortality, 7.1% for prolonged intensive care unit stay, and 6.8% for need for mechanical ventilation. The researchers concluded that pneumonia prevention should be a priority activity in program improvement efforts.
AHRQ-funded; HS025224.
Citation: Lee PT, Krecko LK, Savage S .
Which hospital-acquired conditions matter the most in trauma? An evidence-based approach for prioritizing trauma program improvement.
J Trauma Acute Care Surg 2022 Oct 1;93(4):446-52. doi: 10.1097/ta.0000000000003645..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Pneumonia, Urinary Tract Infection (UTI), Blood Clots
Raper JD, Thomas AM, Lupez K
Can right ventricular assessments improve triaging of low risk pulmonary embolism?
Researchers sought to determine if right ventricle (RV) assessment variables add prognostic accuracy for 5-day clinical deterioration in patients classified low risk by the Simplified Pulmonary Embolism Severity Index and to determine the prognostic importance of RV assessments compared to other variables and to each other. They found that a pulmonary embolism triaging strategy with RV imaging assessments had superior prognostic performance at classifying low risk for 5-day clinical deterioration versus one without.
AHRQ-funded; HS025979.
Citation: Raper JD, Thomas AM, Lupez K .
Can right ventricular assessments improve triaging of low risk pulmonary embolism?
Acad Emerg Med 2022 Jul;29(7):835-50. doi: 10.1111/acem.14484..
Keywords: Respiratory Conditions, Blood Clots, Risk
Rothberg MB, Hamilton AC, Greene MT
Derivation and validation of a risk factor model to identify medical inpatients at risk for venous thromboembolism.
This study’s objective was to compare multiple risk assessment models for hospitalized patients at high risk for venous thromboembolism (VTE). The authors developed a derivation cohort using 6 years of data from 12 hospitals to identify risk factors associated with developing VTE within 14 days of admission. The cohort included 155,026 patients with a 14-day VTE rate of 0.68%. The final multivariable model contained 13 risk factors and good calibration, and performance was evaluated using the C-statistic. The temporal validation cohort had 53,210 patients with a VTE rate of 0.64% and the external cohort had 23,413 patients and a rate of 0.49%. The Cleveland Clinic Model (CCM) outperformed both the Padua and IMPROVE models in the temporal cohort. In the external cohort the CCM C-statistic was similar to Padua and outperformed IMPROVE.
AHRQ-funded; HS022883.
Citation: Rothberg MB, Hamilton AC, Greene MT .
Derivation and validation of a risk factor model to identify medical inpatients at risk for venous thromboembolism.
Thromb Haemost 2022 Jul;122(7):1231-38. doi: 10.1055/a-1698-6506..
Keywords: Inpatient Care, Risk, Blood Clots
Zhang NJ, Rameau P, Julemis M
Automated pulmonary embolism risk assessment using the Wells criteria: validation study.
The authors sought to create an automated process to calculate the Wells score for pulmonary embolism for emergency department patients, which might reduce unnecessary computed tomography pulmonary angiography (CTPA) testing. They designed the process using electronic health records data elements, including free-text fields, and calculated Wells scores for a sample of adult emergency department visits that resulted in a CTPA study for pulmonary embolism at two tertiary care hospitals in New York. After validation, the authors concluded that the development of the automated process to classify risk for pulmonary embolism in emergency department visits was successful.
AHRQ-funded; HS026196.
Citation: Zhang NJ, Rameau P, Julemis M .
Automated pulmonary embolism risk assessment using the Wells criteria: validation study.
JMIR Form Res 2022 Feb 28;6(2):e32230. doi: 10.2196/32230.
Keywords: Blood Clots, Respiratory Conditions, Risk, Emergency Department
Patel SA, Araujo T, Rodriguez LP
Long peripheral catheters: a retrospective review of major complications.
The risk of infectious and noninfectious complications associated with long peripheral catheters (LPCs) is unknown. In this retrospective study of 539 catheters, the investigators did a retrospective review of major complications. Among other discoveries, they found LPCs were often placed for the indications of difficult access and long-term antibiotics.
AHRQ-funded; HS025891.
Citation: Patel SA, Araujo T, Rodriguez LP .
Long peripheral catheters: a retrospective review of major complications.
J Hosp Med 2019 Dec;14(12):758-60. doi: 10.12788/jhm.3313..
Keywords: Healthcare-Associated Infections (HAIs), Adverse Events, Patient Safety, Central Line-Associated Bloodstream Infections (CLABSI), Blood Clots, Infectious Diseases, Risk
Kreutzer L, Yang AD, Sansone C
Barriers to providing VTE chemoprophylaxis to hospitalized patients: a nursing-focused qualitative evaluation.
This study analyzed barriers for administration of VTE chemoprophylaxis to hospitalized patients from nurses. Researchers conducted 14 focus group interviews with nurses from five inpatient units to assess their perceptions of barriers to administration of VTE chemoprophylaxis. Barriers included nurses’ misconceptions that patients did not require chemoprophylaxis, their uncertainty when counseling patients on the importance of chemoprophylaxis, and a lack of comparative data regarding specific refusal rates.
AHRQ-funded; HS024516.
Citation: Kreutzer L, Yang AD, Sansone C .
Barriers to providing VTE chemoprophylaxis to hospitalized patients: a nursing-focused qualitative evaluation.
J Hosp Med 2019 Nov 1;14(10):668-72. doi: 10.12788/jhm.3290..
Keywords: Blood Clots, Patient Safety, Prevention, Inpatient Care, Care Management, Nursing
Leeds IL, DiBrito SR, Canner JK
Cost-benefit limitations of extended, outpatient venous thromboembolism prophylaxis following surgery for Crohn's disease.
This goal of this study was to assess the cost-effectiveness of extended prophylaxis in patients with Crohn's disease after abdominal surgery. A decision tree model was used to assess cost-effectiveness and cost-per-case averted with extended-duration venous thromboembolism prophylaxis following abdominal surgery. Results showed that extended prophylaxis in patients with Crohn's disease postoperatively is not cost-effective when the cumulative incidence of posthospital thrombosis remains less than 4.9%. These findings are driven by the low absolute risk of thrombosis in this population and the considerable cost of universal treatment.
AHRQ-funded; HS024547.
Citation: Leeds IL, DiBrito SR, Canner JK .
Cost-benefit limitations of extended, outpatient venous thromboembolism prophylaxis following surgery for Crohn's disease.
Dis Colon Rectum 2019 Nov;62(11):1371-80. doi: 10.1097/dcr.0000000000001461..
Keywords: Prevention, Digestive Disease and Health, Surgery, Healthcare Costs, Adverse Events, Patient Safety, Blood Clots, Shared Decision Making, Medication
Hoonakker PLT, Carayon P, Salwei ME
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
One possible explanation for user resistance to clinical decision support (CDS) procedures may be poor CDS design. This study describes the design of PE Dx, a CDS built to aid in the diagnosis of pulmonary embolism in the emergency department using human factors methods.
AHRQ-funded; HS022086.
Citation: Hoonakker PLT, Carayon P, Salwei ME .
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
Stud Health Technol Inform 2019 Aug 9;265:134-40. doi: 10.3233/shti190152..
Keywords: Blood Clots, Clinical Decision Support (CDS), Shared Decision Making, Diagnostic Safety and Quality, Emergency Department, Respiratory Conditions
Simon E, Miake-Lye IM, Smith SW
An evaluation of guideline-discordant ordering behavior for CT pulmonary angiography in the emergency department.
The aim of this study was to determine rates of and possible reasons for guideline-discordant ordering of CT pulmonary angiography for the evaluation of suspected pulmonary embolism (PE) in the emergency department. The investigators concluded that many of the guideline-discordant orders were placed for patients who presented with evidence-based risk factors for PE that are not included in the risk stratification scores. They suggest that guideline-discordant ordering may indicate that in the presence of these factors, the assessment of risk made by current scoring systems may not align with clinical suspicion.
AHRQ-funded; HS024376.
Citation: Simon E, Miake-Lye IM, Smith SW .
An evaluation of guideline-discordant ordering behavior for CT pulmonary angiography in the emergency department.
J Am Coll Radiol 2019 Aug;16(8):1064-72. doi: 10.1016/j.jacr.2018.12.015..
Keywords: Respiratory Conditions, Emergency Department, Guidelines, Evidence-Based Practice, Blood Clots
Glass NE, Vadlamani A, Hwang F
Bleeding and thromboembolism after traumatic brain injury in the elderly: a real conundrum.
The objectives of this study were to evaluate the incidence of bleeding, recurrent traumatic brain injury (TBI), and thromboembolic (TE) events after an initial TBI in older adults and to identify which factors contribute to this risk. The researchers found that, among Medicare patients hospitalized with TBI, the incidence of TE events was significantly higher than that of bleeding or recurrent TBI. They identified specific risk factors of bleeding and TE events, which may guide care of older adults after TBI.
AHRQ-funded; HS024560.
Citation: Glass NE, Vadlamani A, Hwang F .
Bleeding and thromboembolism after traumatic brain injury in the elderly: a real conundrum.
J Surg Res 2019 Mar;235:615-20. doi: 10.1016/j.jss.2018.10.021..
Keywords: Brain Injury, Blood Clots, Elderly, Trauma, Injuries and Wounds, Risk, Adverse Events
Blay E, Huang R, Chung JW
Evaluating the impact of the venous thromboembolism outcome measure on the PSI 90 composite quality metric.
Patient Safety Indicator (PSI) 90 is a composite measure widely used in federal pay-for-performance and public reporting programs. A component metric of PSI 90, venous thromboembolism (VTE) rate, has been shown to be subject to surveillance bias and not a valid measure for hospital quality comparisons. A study was conducted to examine how hospital PSI 90 scores would change if the VTE measure were removed from calculation of this composite measure.
AHRQ-funded; HS021857.
Citation: Blay E, Huang R, Chung JW .
Evaluating the impact of the venous thromboembolism outcome measure on the PSI 90 composite quality metric.
Jt Comm J Qual Patient Saf 2019 Mar;45(3):148-55. doi: 10.1016/j.jcjq.2018.08.009..
Keywords: Blood Clots, Patient Safety, Quality Measures, Quality Indicators (QIs), Quality of Care