Venous Thromboembolism Risk

Stratification For Patients With Lower Limb

Trauma And Cast Or Brace Immobilization SURGERY DEPARTMENT
RSUD Soewondo Kendal
2019
■ NAME :
Tri Widya Agisia

■ SUPERVISOR :
dr. Wisnu Murti, Sp.OT
CONTENT
JOURNAL IDENTITY
1
BACKGROUND AND METHODS
2
RESULT AND DISCUSSION
3
CRITICAL APPRAISAL
4
JOURNAL IDENTITY
TITLE
•Venous thromboembolism risk stratification for patients with lower limb trauma and
cast or brace immobilization

AUTHOR

•D. DouilletID 1*, B. NemethID 2,3, A. Penaloza4, G. Le GalID 5,

T. Moumneh1, S. C. CannegieterID 2,6, P. M. Roy1¶

PUBLISHER
•PLOS ONE | https://doi.org/10.1371/journal.pone.0217748 June 20, 2019
BACKGROUND &
METHODS
Background
for patients with non-surgical isolated lower-limb
trauma requiring immobilization is
Thromboprophylaxis a matter of debate

based on Trauma,
develop and
Immobilization and
validate a
Patients’
Our aim was to clinical risk
characteristics (the
stratification
TIP
model
score).

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Methods
The TIP score criteria and the cut-off were selected
by a consensus of international experts (n = 27) using
the Delphi method.

Retrospective validation was performed in a

population based case-control study (MEGA study).

The potential score’s impact in anticoagulant treatment

was assessed in a prospective single-center
observational cohort study
Table 1. Delphi experts’ characteristics.
RESULTS &
DISCUSSIONS
Results
The final TIP score includes :

13 criteria for
trauma,

3 criteria for immobilization,

14 criteria for patient characteristics

9
 Results
Validated retrospectively in a case-
control study, the TIP score shows
good prognostic performance (AUC
0.77). Using <5 as cut-off, the TIP
score identified over 80% of patients
as having a low risk of VTE, hence, no
indication for thromboprophylaxis.
 Table 3. Predictive performance of the TIP score.

Using the Youden index, the optimal threshold value was 6 points with 71.9%, 64.9%, 99.3%
and 3.76% for sensitivity, specificity, negative and positive predictive values, respectively
Table 4. Patients’ characteristics of the prospective cohort.
CONCLUSION

▰ In conclusion, for patients with non-surgical lower-limb trauma

and orthopedic immobilization, the TIP score, based on an
international experts’ consensus using the Delphi method, allows
an individual VTE risk-assessment and shows promising results in
terms of its safety and usefulness for guiding thromboprophylaxis.
An implementation validation study is now required.

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▰ CRITICAL
APPRAISAL
14
 VIA ANALYSIS
VALIDITY
Apakah disebutkan dengan jelas dalam latar belakang mengapa Ya
diperlukan kajian tersebut
Apakah disebut kriteria inklusi studi yang disertakan dan cara Ya
penelusuran pustaka yang relevan

Apakah hasil setiap studi lebih kurang konsisten satu dengan Ya

yang lain
 VIA ANALYSIS

IMPORTANCY
Apakah hasil penelitian merupakan hal yang penting
(tingkat kepentingan hasil penelitian yang dinilai
dengan cara statistik dan secara klinis)? Penting
 V I A analysis
APPLICABLE
Apakah pasien kita mirip dengan karakteristik Ya
pasien studi yang dilakukan penelitian tersebut

Apakah terapi tersebut tersedia, terjangkau dan Ya

dapat diterima pasien
the study is VALID

the study is IMPORTANT

the study is APPLICABLE

THANKYOU!

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