2023, Vol. 27 ›› Issue (36): 5845-5849

Predictive value of five thrombotic risk assessment scales for deep vein thrombosis after intertrochanteric fracture of the femur

Xiang Feifan1, 2, Fan Wei1, 2, Wei Daiqing1, 2, Liang Jie1, 2, Ye Junwu1, 2, Yang Yunkang1, 2   

Abstract: BACKGROUND: Once the deep vein thrombosis of the lower extremities caused by intertrochanteric fracture falls off, pulmonary embolism will be fatal. At this stage, there are many deep vein thrombosis evaluation scales available in clinical practice, but their application value in patients with intertrochanteric fractures of the femur is not clear.  
OBJECTIVE: To compare the predictive value of five different thrombosis risk assessment scales for lower extremity deep vein thrombosis in patients with intertrochanteric fractures of the femur.
METHODS: The data of 254 patients with intertrochanteric fractures admitted to the Department of Orthopedics, Affiliated Hospital of Southwest Medical University from July 2016 to July 2021 were retrospectively analyzed. According to the examination results of the lower extremity venous ultrasound, the patients were divided into the deep vein thrombosis group and the non-deep vein thrombosis group. Capprini, RAPT, Autar, Pauda and Wells scales were used to evaluate the possible risk of deep vein thrombosis in patients. The scores of five thrombosis risk assessment scales were compared between the two groups. Simultaneously, the receiver operating characteristic curve was drawn and the area under the curve was calculated to analyze the predictive value of five thrombosis risk assessment scales for lower extremity deep vein thrombosis in patients with intertrochanteric fracture.  
RESULTS AND CONCLUSION: (1) The Wells score, Autar score and RAPT score in the deep vein thrombosis group were significantly higher than those in the non-deep vein thrombosis group (P < 0.05). (2) The areas under the curve of Wells, Capprini, RAPT, Autar and Pauda were 0.916, 0.751, 0.767, 0.544 and 0.575, respectively. (3) The sensitivities of Wells, Capprini, RAPT, Autar and Pauda in the diagnosis of deep vein thrombosis in patients with intertrochanteric fracture were 93.22%, 77.97%, 74.01%, 58.76% and 36.16%, respectively. The specificities were 64.94%, 59.74%, 35.06%, 49.35% and 74.03%, respectively. (4) All the above five thrombosis risk assessment scales have certain predictive values for the occurrence of deep vein thrombosis in the lower extremity of hospitalized patients with intertrochanteric fracture, but the Wells risk assessment scale has a relatively high predictive value, followed by Capprini and RAPT assessment scale. The risk assessment value of Wells scale is relatively accurate for whether the patients with intertrochanteric fracture have thrombus. The RAPT scale is applicable to the risk assessment of possible thrombosis in all orthopedic trauma patients.

Key words: deep venous thrombosis, intertrochanteric fracture of femur, rating scale, predictive value, receiver operating characteristic curve, risk assessment