应用RIETE评分来识别肺栓塞的低风险患者:来自COMMAND VTE注册表
Yuta Tsujisaka1, Yugo Yamashita1, Takeshi Morimoto2
1Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Thrombosis research
|November 3, 2023
概括
瑞特得分有效地识别了低风险的肺栓塞 (PE) 患者进行家庭治疗. 这一在大型注册表中的验证证实了其在30天内预测不良事件的实用性.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 临床风险分层的临床风险分层
背景情况:
- 瑞特得分有助于识别低风险肺栓塞 (PE) 患者适合家庭治疗.
- 对RIETE评分预测能力的外部验证是有限的.
研究的目的:
- 在一个大规模的现实世界队列中对RIETE评分进行外部验证.
- 评估RIETE评分能够预测急性PE患者的不良结果的能力.
主要方法:
- 该研究使用了COMMAND VTE注册表的数据,包括1479名连续患有急性PE的患者.
- 患者被分为两组:RIETE得分为0 (n=260) 和RIETE得分≥1 (n=1219).
- 综合终点是所有原因的死亡,复发性PE或重大出血在10天和30天后被评估.
主要成果:
- 与RIETE分数≥1.1的患者相比,RIETE分数为0的患者在10天 (0.4%对6.7%) 和30天 (0.4%对10.0%) 的复合终点发生率明显较低.
- 与sPESI得分相比,RIETE得分对30天复合终点的预测能力优于sPESI得分 (AUC0.77与0.71).
- 在10天复合终点上,RIETE得分显示出比sPESI得分更好的数值预测能力 (AUC 0.77对比0.73).
结论:
- 在这个庞大的现实世界注册表中,RIETE评分得到了良好的验证.
- 一个RIETE分数为0可靠地识别了急性PE患者的10天和30天不良结果的低风险.
- 瑞特得分是肺栓塞管理中风险分层的一个有价值的工具.
相关概念视频
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
10
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
10
01:27Pulmonary Embolism III: Nursing Management
15
A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
15
01:29Pulmonary Embolism I: Introduction
7
Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
7
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
12
The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
12
01:29Venous Thrombosis III: Interprofessional Care
10
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
10
01:30Venous Thrombosis IV: Nursing Management
14
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
14