Related Experiment Video
Updated: Feb 24, 2026
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
The Michigan Risk Score to predict peripherally inserted central catheter-associated thrombosis
V Chopra1,2,3, S Kaatz4, A Conlon1,2
1The Division of Hospital Medicine, Department of Medicine, University of MIchigan School of Medicine, Ann Arbor, MI, USA.
Abstract:
Essentials How best to quantify thrombosis risk with peripherally inserted central catheters (PICC) is unknown. Data from a registry were used to develop the Michigan Risk Score (MRS) for PICC thrombosis. Five risk factors were associated with PICC thrombosis and used to develop a risk score. MRS was predictive of the risk of PICC thrombosis and can be useful in clinical practice.
Summary:
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. 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. Four risk classes were created based on thrombosis risk. 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, and IV, respectively. The risk classification rule was strongly 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.
Insights
The Michigan Risk Score (MRS) quantifies thrombosis risk for peripherally inserted central catheters (PICCs). This score predicts deep vein thrombosis (DVT) risk, aiding clinical decisions for PICC appropriateness.
Area of Science:
- Medical Devices
- Vascular Access
- Thrombosis Research
Background:
- Peripherally inserted central catheters (PICCs) are linked to upper extremity deep vein thrombosis (DVT).
- Quantifying thrombosis risk associated with PICCs is crucial for patient safety.
- Existing methods for risk assessment are insufficient.
Purpose of the Study:
- To develop and validate a risk score for predicting PICC-related DVT.
- To identify key risk factors associated with PICC-DVT.
- To stratify patients into distinct risk classes for thrombosis.
Main Methods:
- Utilized data from the Michigan Hospital Medicine Safety Consortium.
- Employed a logistic, mixed-effects model to identify DVT predictors.
- Developed the Michigan Risk Score (MRS) by assigning points to risk factors.
- Validated the score internally using bootstrapping.
Main Results:
- Identified five risk factors for PICC-DVT: history of DVT, multi-lumen PICC, active cancer, concurrent CVC use, and elevated white blood cell count.
- Developed four risk classes (I-IV) with increasing DVT rates (0.9% to 4.7%).
- The MRS demonstrated strong predictive capability for PICC-DVT.
Conclusions:
- The Michigan PICC-DVT Risk Score (MRS) provides a validated tool for estimating thrombosis risk.
- The MRS can assist clinicians in determining the appropriateness of PICC insertion.
- This score enhances the management of patients requiring PICCs.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:26Peripheral Artery Disease IV: Nursing Management
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:29Endocarditis IV: Nursing Management
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:27Assessment of the Cardiovascular System III: Palpation
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...