三种量表预测下肢骨折患者术后深静脉血栓形成的准确度分析

Analysis of the accuracy of three scales in predicting postoperative deep vein thrombosis in patients with lower limb fractures

目的 评估 Caprini 风险评估量表 (Caprini risk assessment scales,Caprini RAS)、Wells 量表和 Autar 风险评估量表 (Autar risk assessment scales,Autar RAS) 评分预测下肢骨折患者术后深静脉血栓 (deep vein thrombosis,DVT) 风险准确性。方法 选取我院 2020 年 11 月 27 日至 2023 年 10 月 27 日手术治疗的下肢骨折患者。采用诊断试验方法分为病例组 (确诊术后 DVT,n=36) 和对照组 (未确诊术后 DVT,n=72)。入院 24 h 内收集患者 Caprini RAS、Wells 量表和 Autar RAS 评分。结果 病例组 Caprini RAS、Wells 量表和 Autar RAS 分数高于对照组 (P 均 < 0.05)。Caprini RAS、Wells 量表及 Autar RAS 的 AUC 分别为 0.941 (0.879~0.977)、0.868 (0.790~0.926) 以及 0.640 (0.542~0.730),最佳截断值分别为 > 11 分、> 2 分和 > 7 分。Caprini RAS (> 11 分),Wells 量表 (> 2 分) 和 Autar RAS (> 7 分) 患者与确诊术后 DVT 患者的 Kappa 值分别为 0.789,0.577 和 0.245。结论 Caprini RAS > 11 分的下肢骨折患者需要更加积极的预防措施和影像学检查。

Objective To analyze the accuracy of Caprini risk assessment scales (Caprini RAS),Wells scale and Autar risk assessment scales (Autar RAS) in predicting postoperative deep vein thrombosis in patients with lower limb fractures.Methods Patients with lower limb fractures treated surgically between 3 February 2022 and 1 September 2023 in our hospital were selected.They were divided into case group (confirmed postoperative DVT,n=36) and control group (unconfirmed postoperative DVT,n=36) using diagnostic test method.Patients’ Caprini RAS,Wells scale and Autar RAS scores were collected within 24 hours of admission.Results Caprini RAS,Wells scale and Autar RAS scores were higher in the case group than in the control group (all P < 0.05).The AUCs for Caprini RAS,Wells scale and Autar RAS were 0.941 (0.879-0.977),0.868 (0.790-0.926) and 0.640 (0.542-0.730),with optimal cut-off values of > 11,> 2,and > 7 points,respectively.The Kappa values for patients with Caprini RAS(> 11 points),Wells scale (> 2 points),and Autar RAS (> 7 points) versus patients with confirmed postoperative DVT were 0.789,0.577,and 0.245,respectively.Conclusions Patients with lower extremity fractures and a Caprini RAS score > 11 need more aggressive preventive measures and imaging.