The effect of obligatory Padua prediction scoring in hospitalized medically ill patients: A retrospective cohort study

Abstract

Background Venous thromboembolism (VTE) is considered a preventable cause of mortality. The evidence for the benefit of VTE prophylaxis in acute medical patients is non-conclusive. Meta-analysis of RCTs failed to demonstrate reduction of all-cause mortality, while showing higher risk of bleeding. The Israeli Ministry of Health has instructed to assess all acute medical patients for the risk for VTE using the Padua Prediction Score, without mandating prophylaxis. Aim To evaluate the effect of filling the Padua score on clinical outcomes and VTE prophylaxis rates. Methods Retrospective Study was performed in Israel during the years 2014–2017. The participants were divided to Padua compliance vs non-compliance group. Primary outcome: 30-day mortality. Secondary outcomes: 90-day incidence of VTE and suspected major bleeding. A propensity-weighted logistic multiple regression was performed. Results 18,890 patients were included in the study. The fulfillment of the Padua score was associated with an increased use of VTE prophylaxis, OR 1.66 (95% CI 1.49–1.84). However, there was no reduction of mortality or VTE events, OR 1.13 (95% CI 0.97–1.31) and OR 1.22 (95% CI 0.79–1.8) respectively. Hospitalizations related to hemoglobin decrease were not statistically different between the two groups. Conclusions Padua score for the assessment of VTE risk in medical wards was associated with higher administration of pharmacological prophylaxis without reduction in VTE or mortality rate. Its usage should be reassessed as a performance measure.