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Updated: Jun 28, 2025

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Inaccuracy of Initial Clinical Mobility Assessment in Venous Thromboembolism Risk Stratification.

Erik H Hoyer1, Aditya Bhave2, Wingel Xue2

  • 1Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, Md; Department of Internal Medicine, School of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md; Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Md.

The American Journal of Medicine
|April 22, 2024
PubMed
Summary

Objective mobility assessment using the Johns Hopkins-Highest Level of Mobility (JH-HLM) tool can improve venous thromboembolism risk stratification in hospitalized patients. This approach identifies more patients with reduced mobility, potentially preventing adverse events.

Keywords:
Patient mobilityRisk assessmentVenous thromboembolism

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Area of Science:

  • Medical research
  • Clinical informatics
  • Patient safety

Background:

  • Hospitalized patients face increased risk of venous thromboembolism (VTE) due to decreased mobility.
  • Current VTE risk assessments often rely on subjective and non-standardized mobility evaluations, leading to potential underestimation of risk and inadequate preventative measures.

Purpose of the Study:

  • To evaluate the effectiveness of the Johns Hopkins-Highest Level of Mobility (JH-HLM) score as an objective measure for assessing reduced mobility in hospitalized patients.
  • To compare the predictive value of JH-HLM scores against traditional admitting health care professional assessments for hospital-acquired VTE risk.

Main Methods:

  • A retrospective study analyzed 1715 patients at a quaternary academic hospital.
  • Data included Padua risk tool assessments and objective JH-HLM scores; reduced mobility was defined as JH-HLM ≤3 for ≥3 consecutive days.
  • Multivariable logistic regression assessed the association between reduced mobility (JH-HLM) and hospital-acquired VTE, comparing with admitting assessments.

Main Results:

  • A total of 33 patients (1.9%) developed VTE.
  • Reduced mobility by JH-HLM scores was significantly associated with VTE (adjusted OR: 2.53, P = .012), unlike the Padua assessment.
  • JH-HLM identified 19.1% of patients with reduced mobility versus 6.5% by admitting professionals, indicating 37 patients were misclassified.

Conclusions:

  • Subjective initial mobility assessments may not accurately reflect a patient's mobility status throughout their hospital stay.
  • Objective mobility assessment tools, such as JH-HLM, are crucial for accurate VTE risk assessment and improving the implementation of preventative strategies.