Matthew B Bloom1, Jeffrey Johnson2, Oksana Volod3, Ernest Y Lee4, Terris White5, Daniel R Margulies6. 1. Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. Electronic address: matthew.bloom@cshs.org. 2. Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. Electronic address: jeffrey.johnson@cshs.org. 3. Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. Electronic address: oksana.volod@cshs.org. 4. UCLA-Caltech Medical Scientist Training Program, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA. Electronic address: ernlee@mednet.ucla.edu. 5. United Regional Health Care System, Wichita Falls, TX, USA. Electronic address: terris.white@gmail.com. 6. Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. Electronic address: daniel.margulies@cshs.org.
Abstract
BACKGROUND: The Warkentin 4-T scoring system for determining the pretest probability of heparin-induced thrombocytopenia (HIT) has been shown to be inaccurate in the ICU and does not take into account body mass index (BMI). METHODS: Prospectively collected data on patients in the surgical and cardiac ICU between January 2007 and February 2016 who were presumed to have HIT by clinical suspicion were reviewed. Patients were categorized into 3 BMI groups and assigned scores: Normal weight, overweight, and obese. Multivariate analyses were used to identify independent predictors of HIT. RESULTS: A total of 523 patients met inclusion criteria. Multivariate analysis showed that only BMI, Timing, and oTher variables were independently associated with HIT. This new 3-T model was better than a five-component model consisting of the entire 4-T scoring system plus BMI (AUC = 0.791). CONCLUSIONS: Incorporating patient 'T'hickness into a pretest probability model along with platelet 'T'iming and the exclusion of o'T'her causes of thrombocytopenia yields a simplified "3-T" scoring system that has increased predictive accuracy in the ICU.
BACKGROUND: The Warkentin 4-T scoring system for determining the pretest probability of heparin-induced thrombocytopenia (HIT) has been shown to be inaccurate in the ICU and does not take into account body mass index (BMI). METHODS: Prospectively collected data on patients in the surgical and cardiac ICU between January 2007 and February 2016 who were presumed to have HIT by clinical suspicion were reviewed. Patients were categorized into 3 BMI groups and assigned scores: Normal weight, overweight, and obese. Multivariate analyses were used to identify independent predictors of HIT. RESULTS: A total of 523 patients met inclusion criteria. Multivariate analysis showed that only BMI, Timing, and oTher variables were independently associated with HIT. This new 3-T model was better than a five-component model consisting of the entire 4-T scoring system plus BMI (AUC = 0.791). CONCLUSIONS: Incorporating patient'T'hickness into a pretest probability model along with platelet 'T'iming and the exclusion of o'T'her causes of thrombocytopenia yields a simplified "3-T" scoring system that has increased predictive accuracy in the ICU.
Authors: T L Bauer; G Arepally; B A Konkle; B Mestichelli; S S Shapiro; D B Cines; M Poncz; S McNulty; J Amiral; W W Hauck; R N Edie; J D Mannion Journal: Circulation Date: 1997-03-04 Impact factor: 29.690
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