The Michigan PICC-DVT Risk Score offers a novel way to estimate risk of DVT associated with PICCs and can help inform appropriateness of PICC insertion” Chopra et al (2017).
BACKGROUND: Peripherally inserted central catheters (PICCs) are associated with upper extremity deep vein thrombosis (DVT). We developed a score to predict risk of PICC-related thrombosis.
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METHODS: Using data from the Michigan Hospital Medicine Safety consortium, image-confirmed upper-extremity DVT cases were identified. A logistic, mixed effects model with hospital-specific random intercepts was used to identify factors associated with PICC-DVT. Points were assigned to each predictor, stratifying patients into four classes of risk. Internal validation was performed by bootstrapping with assessment of calibration and discrimination of the model.
RESULTS: Of 23,010 patients who received PICCs, 475 (2.1%) developed symptomatic PICC-DVT. Risk factors associated with PICC-DVT included: history of DVT; multi-lumen PICC; active cancer; presence of another CVC when the PICC was placed; and white blood cell count greater than 12,000. Thrombosis rates were 0.9% for class I, 1.6% for class II, 2.7% for class III and 4.7% for class IV, with marginal predicted probabilities of 0.9% (0.7, 1.2), 1.5% (1.2, 1.9), 2.6% (2.2, 3.0) and 4.5% (3.7, 5.4) for classes I, II, III, IV and V, respectively. The risk classification rule was associated with PICC-DVT, with odds ratios of 1.68 (95% CI: 1.19, 2.37), 2.90 (95% CI: 2.09, 4.01) and 5.20 (95% CI: 3.65, 7.42) for risk classes II, III and IV vs. risk class I, respectively.
CONCLUSION: The Michigan PICC-DVT Risk Score offers a novel way to estimate risk of DVT associated with PICCs and can help inform appropriateness of PICC insertion.
Chopra, V., Kaatz, S., Conlon, A., Paje, D., Grant, P.J., Rogers, M.A.M., Bernstein, S.J., Saint, S. and Flanders, S.A. (2017) The Michigan Risk Score to Predict Peripherally Inserted Central Catheter-Associated Thrombosis. August 10th. [epub ahead of print].
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