Abstract
Study design
Cross-sectional study.
Objectives
Deep vein thrombosis (DVT) presents a significant risk of complication in patients with spinal cord injury (SCI), necessitating accurate screening methods. While the Caprini Risk Assessment Model (Caprini RAM) has seen extensive use for DVT screening, its efficacy remains under scrutiny.
Setting
First Affiliated Hospital of China University of Science and Technology.
Methods
We created and evaluated three nomograms for their effectiveness in DVT screening. Model 1 incorporated variables such as age, D-dimer level, red blood cell (RBC) counts, platelet counts, presence of type 2 diabetes mellitus, high blood pressure, mode and level of injury, degree of impairments, and Caprini scores. Model 2 was derived from Caprini scores alone, and Model 3 focused on independent risk factors. We assessed these models using the area under the curve (AUC) of the receiver operating characteristic (ROC), calibration curves, and decision curve analysis (DCA), employing bootstrap resampling tests (500 iterations) to determine their accuracy, discriminative ability, and clinical utility. Internal validation was performed on a separate cohort. Nomogram was established with well-fitted calibration curves for model 1, 2 and 3(AUC = 0.808, 0.751 and 0.797; 95%CI = 0.76–0.86, 0.70–0.80 and 0.75–0.84; respectively), indicating model 1 outperformed the others in prediction DVT risk, followed by model 3 and 2. These findings were consistent in the validation cohort, with DCA further corroborating our conclusions.
Conclusion
A nomogram integrating clinical data with Caprini RAM provides a superior option for DVT screening in SCI patients within rehabilitation settings, outperforming Caprini RAM.
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Data availability
Data and materials used in this study are available upon reasonable request from the first and corresponding author. Additionally, the original data can be accessed through the following link: https://osf.io/ax27c/?view_only=c1f4ded911174c0f9e62cdf5ee89326a.
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Acknowledgements
We would like to thank Tingting Zhang, CuicuiChang, Tingting Bao, Nanzu Chengjiang, Liai Sun and Lina Ma for collecting the data. During the preparation of this work the authors used Chatgpt 4.0 in order to improve the English language writing. After using this tool, the authors reviewed and edited the content as needed and takes full responsibility for the content of the publication.
Funding
This study was supported by the National Natural Science Foundation of China (81972146; 82002393; 82272599), 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (ZYGD23014), and the National Key R&D Program of China (2023YFC3603800; 2023YFC3603802). The funders played no role in the design, conduct, or reporting of this study.
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JLZ wrote the main manuscript text and designed the study, statistical analyzed and interpreted the data. CW organized for collecting the data. CQH supervised the study. YHY planned the project. The authors all read and approved the final manuscript.
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Informed consent was waived due to the retrospective nature of the study, coinciding with the ethical requirements and waiver from the ethics committee.
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We certify that all applicable institutional and governmental regulations concerning the ethical use of human data were followed during the course of this research. This study was performed in line with the principles of the Declaration of Helsinki. And, this study has received approval from the Ethics Committee of First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital); approval number: 2020-RE-008.
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Zhang, J., Wang, C., He, C. et al. Development and validation of a novel screening tool for deep vein thrombosis in patients with spinal cord injury: A five-year cross-sectional study. Spinal Cord 62, 523–531 (2024). https://doi.org/10.1038/s41393-024-01014-4
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DOI: https://doi.org/10.1038/s41393-024-01014-4
