Evidence map›Paper›PMID 24626961›Full record

ArticleChest2014

Rethinking guidelines for VTE risk among nursing home residents: a population-based study merging medical record detail with standardized nursing home assessments.

Cynthia L Leibson, Tanya M Petterson, Carin Y Smith, Kent R Bailey, Jane A Emerson, Aneel A Ashrani, Paul Y Takahashi, John A Heit

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Chest, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Cynthia L LeibsonDivision of Epidemiology, Department of Internal Medicine, Mayo Clinic, Rochester, MN. Electronic address: leibson@mayo.edu.
Tanya M PettersonDivision of Biomedical Statistics and Informatics, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Carin Y SmithDivision of Biomedical Statistics and Informatics, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Kent R BaileyDivision of Biomedical Statistics and Informatics, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Jane A EmersonDivision of Epidemiology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Aneel A AshraniDepartment of Health Sciences Research, and the Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Paul Y TakahashiDivision of Primary Care, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
John A HeitDepartment of Health Sciences Research, and the Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, MN.

Funding

RISK FACTORS FOR VENOUS THROMBOEMBOLISM IN THE COMMUNITYR01HL066216 · NHLBI · MAYO CLINIC ROCHESTER · PI ASHRANI, ANEEL ARJUN, BAILEY, KENT R · 2001 to 2019
$10.4M
Rochester Epidemiology ProjectR01AG034676 · NIA · MAYO CLINIC ROCHESTER · PI ROCCA, WALTER A, ST SAUVER, JENNIFER LYNN · 2010 to 2019
$9.5M
The burden of venous thromboembolism within the nursing home populationR01AG031027 · NIA · MAYO CLINIC ROCHESTER · PI LEIBSON, CYNTHIA L · 2007 to 2010
$1.5M
NHLBI NIH HHS R01 HL066216NHLBI NIH HHS R01HL 66216-9NIA NIH HHS R01 AG031027NIA NIH HHS R01 AG034676NIA NIH HHS R01AG 31027-4
6 · The paper itself

Abstract

backgroundNursing home (NH) residents are at increased risk for both VTE and bleeding from pharmacologic prophylaxis. Construction of prophylaxis guidelines is hampered by NH-specific limitations with VTE case identification and characterization of risk. We addressed these limitations by merging detailed provider-linked Rochester Epidemiology Project (REP) medical records with Centers for Medicare and Medicaid Services Minimum Data Set (MDS) NH assessments.

methodsThis population-based nested case-control study identified all Olmsted County, Minnesota, residents with first-lifetime VTE October 1, 1998, through December 31, 2005, while a resident of an NH (N = 91) and one to two age-, sex-, and calendar year-matched NH non-VTE control subjects. For each NH case without hospitalization 3 months before VTE (n = 23), we additionally identified three to four nonhospitalized NH control subjects. REP and MDS records were reviewed before index date (VTE date for cases; respective REP encounter date for control subjects) for numerous characteristics previously associated with VTE in non-NH populations. Data were modeled using conditional logistic regression.

resultsThe multivariate model consisting of all cases and control subjects identified only three characteristics independently associated with VTE: respiratory infection vs no infection (OR, 5.9; 95% CI, 2.6-13.1), extensive or total assistance with walking in room (5.6, 2.5-12.6), and general surgery (3.3, 1.0-10.8). In analyses limited to nonhospitalized cases and control subjects, only nonrespiratory infection vs no infection was independently associated with VTE (8.8, 2.7-29.2).

conclusionsContrary to previous assumptions, most VTE risk factors identified in non-NH populations do not apply to the NH population. NH residents with infection, substantial mobility limitations, or recent general surgery should be considered potential candidates for VTE prophylaxis.

Indexed as

Medical RecordsNursing HomesPractice Guidelines as TopicAged, 80 and overFemaleGeriatric AssessmentHumansIncidenceMaleMinnesotaMobility LimitationRetrospective StudiesRisk FactorsVenous Thromboembolism

Identifiers

PMID24626961
PMCPMC4122277

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.