ABSTRACT
BACKGROUND: Antithrombotic guidance statements for hospitalized patients with coronavirus disease 2019 (COVID-19) suggest a universal thromboprophylactic strategy with potential to escalate doses in high-risk patients. To date, no clear approach exists to discriminate patients at high risk for venous thromboembolism (VTE). OBJECTIVES: The objective of this study is to externally validate the IMPROVE-DD risk assessment model (RAM) for VTE in a large cohort of hospitalized patients with COVID-19 within a multihospital health system. METHODS: This retrospective cohort study evaluated the IMPROVE-DD RAM on adult inpatients with COVID-19 hospitalized between March 1, 2020, and April 27, 2020. Diagnosis of VTE was defined by new acute deep venous thrombosis or pulmonary embolism by Radiology Department imaging or point-of-care ultrasound. The receiver operating characteristic (ROC) curve was plotted and area under the curve (AUC) calculated. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using standard methods. RESULTS: A total of 9407 patients were included, with a VTE prevalence of 2.9%. The VTE rate was 0.4% for IMPROVE-DD score 0-1 (low risk), 1.3% for score 2-3 (moderate risk), and 5.3% for score ≥ 4 (high risk). Approximately 45% of the total population scored high VTE risk, while 21% scored low VTE risk. IMPROVE-DD discrimination of low versus medium/high risk showed sensitivity of 0.971, specificity of 0.218, PPV of 0.036, and NPV of 0.996. ROC AUC was 0.702. CONCLUSIONS: The IMPROVE-DD VTE RAM demonstrated very good discrimination to identify hospitalized patients with COVID-19 as low, moderate, and high VTE risk in this large external validation study with potential to individualize thromboprophylactic strategies.
ABSTRACT
OBJECTIVE: To compare the effectiveness of human papillomavirus (HPV) testing and cervical cytologic analysis in monitoring patients after treatment for cervical intraepithelial neoplasia. MATERIALS AND METHODS: A retrospective study comparing cytologic analysis and HPV testing using the follow-up protocol recommended by the American Society for Colposcopy and Cervical Pathology Consensus Conference. Sixty-one patients were seen for a total of 193 follow-up patient visits. In 120 visits, both cytologic and HPV results were available. Specificity, sensitivity, positive and negative predictive values, and the rate of referral to colposcopy were calculated. RESULTS: In 68 visits, both HPV and cytologic results were negative, and in 19, both were positive. In 21 visits, cytologic results were positive and HPV results were negative, and in 12 visits, cytologic results were negative and HPV results were positive. The specificity of cytologic analysis and HPV testing was 68.3% and 75.8%, respectively (p = .16). The positive predictive value for cytologic analysis and HPV testing was 6.5% and 7.5%, respectively, and the negative predictive value was 100% and 98.9%, respectively. Had either test been used alone, cytologic analysis would have referred 40 patients to colposcopy and HPV testing would have referred 31 patients. Had both been used in combination, 52 patients would have required colposcopy with no significant improvement in the amount of disease detected. CONCLUSIONS: Both cytologic analysis and HPV testing are equally effective in monitoring patients after treatment for cervical intraepithelial neoplasia. The simultaneous use of cytologic analysis and HPV testing significantly increased colposcopy referrals without increasing the amount of disease detected.