Michael Karsy1, Mohammed A Azab1, Jonathan Harper1, Hussam Abou-Al-Shaar2, Jian Guan1, Ilyas Eli1, Andrea A Brock1, Ryan D Ormond3, Patrick W Hosokawa4, Ramkiran Gouripeddi5, Ryan Butcher5, Chad D Cole6, Sarah T Menacho1, William T Couldwell7. 1. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. 2. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA; Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, New York, USA. 3. Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA. 4. Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, Colorado, USA. 5. Department of Bioinformatics, University of Utah, Salt Lake City, Utah, USA. 6. Department of Neurosurgery, New York Medical College, Valhalla, New York, USA. 7. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. Electronic address: neuropub@hsc.utah.edu.
Abstract
BACKGROUND: The use of venous duplex ultrasonography (VDU) for confirmation of deep venous thrombosis in neurosurgical patients is costly and requires experienced personnel. We evaluated a protocol using D-dimer levels to screen for venous thromboembolism (VTE), defined as deep venous thrombosis and asymptomatic pulmonary embolism. METHODS: We used a retrospective bioinformatics analysis to identify neurosurgical inpatients who had undergone a protocol assessing the serum D-dimer levels and had undergone a VDU study to evaluate for the presence of VTE from March 2008 through July 2017. The clinical risk factors and D-dimer levels were evaluated for the prediction of VTE. RESULTS: In the 1918 patient encounters identified, the overall VTE detection rate was 28.7%. Using a receiver operating characteristic curve, an area under the curve of 0.58 was identified for all D-dimer values (P = 0.0001). A D-dimer level of ≥2.5 μg/mL on admission conferred a 30% greater relative risk of VTE (sensitivity, 0.43; specificity, 0.67; positive predictive value, 0.27; negative predictive value, 0.8). A D-dimer value of ≥3.5 μg/mL during hospitalization yielded a 28% greater relative risk of VTE (sensitivity, 0.73; specificity, 0.32; positive predictive value, 0.24; negative predictive value, 0.81). Multivariable logistic regression showed that age, male sex, length of stay, tumor or other neurological disease diagnosis, and D-dimer level ≥3.5 μg/mL during hospitalization were independent predictors of VTE. CONCLUSIONS: The D-dimer protocol was beneficial in identifying VTE in a heterogeneous group of neurosurgical patients by prompting VDU evaluation for patients with a D-dimer values of ≥3.5 μg/mL during hospitalization. Refinement of this screening model is necessary to improve the identification of VTE in a practical and cost-effective manner.
BACKGROUND: The use of venous duplex ultrasonography (VDU) for confirmation of deep venous thrombosis in neurosurgical patients is costly and requires experienced personnel. We evaluated a protocol using D-dimer levels to screen for venous thromboembolism (VTE), defined as deep venous thrombosis and asymptomatic pulmonary embolism. METHODS: We used a retrospective bioinformatics analysis to identify neurosurgical inpatients who had undergone a protocol assessing the serum D-dimer levels and had undergone a VDU study to evaluate for the presence of VTE from March 2008 through July 2017. The clinical risk factors and D-dimer levels were evaluated for the prediction of VTE. RESULTS: In the 1918 patient encounters identified, the overall VTE detection rate was 28.7%. Using a receiver operating characteristic curve, an area under the curve of 0.58 was identified for all D-dimer values (P = 0.0001). A D-dimer level of ≥2.5 μg/mL on admission conferred a 30% greater relative risk of VTE (sensitivity, 0.43; specificity, 0.67; positive predictive value, 0.27; negative predictive value, 0.8). A D-dimer value of ≥3.5 μg/mL during hospitalization yielded a 28% greater relative risk of VTE (sensitivity, 0.73; specificity, 0.32; positive predictive value, 0.24; negative predictive value, 0.81). Multivariable logistic regression showed that age, male sex, length of stay, tumor or other neurological disease diagnosis, and D-dimer level ≥3.5 μg/mL during hospitalization were independent predictors of VTE. CONCLUSIONS: The D-dimer protocol was beneficial in identifying VTE in a heterogeneous group of neurosurgical patients by prompting VDU evaluation for patients with a D-dimer values of ≥3.5 μg/mL during hospitalization. Refinement of this screening model is necessary to improve the identification of VTE in a practical and cost-effective manner.
Authors: Pan Wang; Honglin Zhao; Qingchun Zhao; Fan Ren; Ruifeng Shi; Xingyu Liu; Jinghao Liu; Hongyu Liu; Gang Chen; Jun Chen Journal: Cancer Manag Res Date: 2020-06-30 Impact factor: 3.989
Authors: Darwish Alabyad; Srikant Rangaraju; Michael Liu; Rajeel Imran; Christine L Kempton; Milad Sharifpour; Sara C Auld; Manila Gaddh; Roman Sniecinski; Cheryl L Maier; Jeannette Guarner; Alexander Duncan; Fadi Nahab Journal: PLoS One Date: 2021-03-19 Impact factor: 3.240