Development and prospective validation of a novel risk score for predicting the risk of lower extremity deep vein thrombosis among multiple trauma patients.

ABSTRACT

INTRODUCTION: Trauma patients have an increased risk of deep vein thrombosis (DVT). Early identification of patients with a high risk of DVT after trauma is crucial for thromboembolism prophylaxis. We aimed to develop and prospectively validate a novel risk score based on a nomogram to predict lower extremity DVT among multiple trauma patients. MATERIALS AND METHODS: Clinical data were collected from 281 multiple trauma patients who were admitted to our trauma center within 24 h of admission from January 2016 to September 2019 to develop a novel DVT risk score. The DVT risk estimates were then calculated prospectively based on the score in a new study cohort from October 2019 to July 2020. The technique of least absolute shrinkage and selection operator (LASSO) was used to select variables for the early prediction of DVT in multiple trauma patients. The DVT risk assessment score (DRAS) was constructed by incorporating related features based on the LASSO analysis and nomogram prediction model. Further, the multiple trauma patients were divided into various risk groups according to the DRAS. The incidence of lower extremity DVT was compared between groups and the discrimination of the DRAS was assessed using the area under the curve (AUC). RESULTS: Based on the LASSO method, seven variables (age, injury severity score, body mass index, lower extremity fracture, D-dimer level, fibrin degradation products, and prothrombin time) were included in the DRAS. A total of 166 multiple trauma patients were enrolled in the prospective study. Increased risk of DVT after trauma was related to higher DRAS. The area under the receiver operating characteristic (ROC) curve for the DRAS was 0.890 (0.841-0.940) in the validation cohort. Moreover, the discriminatory capacity of the DRAS was superior to that of each variable independently and the TESS score (P < 0.05). CONCLUSIONS: We developed and prospectively validated the DRAS as a reliable tool for predicting the risk of lower extremity DVT among patients with multiple trauma. This may help guide trauma surgeons in making sound decisions in the administration of DVT prophylaxis.