Inaccuracy of Initial Clinical Mobility Assessment in Venous Thromboembolism Risk Stratification

Erik H Hoyer; Aditya Bhave; Wingel Xue; Elliott R Haut; Brandyn D Lau; Peggy Kraus; Alison E Turnbull; Dauryne Shaffer; Lisa Aronson Friedman; Daniel Young; Daniel J Brotman; Michael B Streiff

doi:10.1016/j.amjmed.2024.04.003

Inaccuracy of Initial Clinical Mobility Assessment in Venous Thromboembolism Risk Stratification

Am J Med. 2024 Apr 21:S0002-9343(24)00205-5. doi: 10.1016/j.amjmed.2024.04.003. Online ahead of print.

Authors

Affiliations

¹ Department 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. Electronic address: ehoyer1@jhmi.edu.
² Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Md.
³ Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md; Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md; Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md; Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Md; Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
⁴ Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Md; Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Md.
⁵ Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Md.
⁶ Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Md; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Md.
⁷ Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.
⁸ Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Md.
⁹ Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, Md; Department of Physical Therapy, University of Nevada Las Vegas, Nev.
¹⁰ Department of Internal Medicine, School of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md.
¹¹ Department of Internal Medicine, School of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Md.

PMID: 38649003
DOI: 10.1016/j.amjmed.2024.04.003

Abstract

Background: Venous thromboembolism risk increases in hospitals due to reduced patient mobility. However, initial mobility evaluations for thromboembolism risk are often subjective and lack standardization, potentially leading to inaccurate risk assessments and insufficient prevention.

Methods: A retrospective study at a quaternary academic hospital analyzed patients using the Padua risk tool, which includes a mobility question, and the Johns Hopkins-Highest Level of Mobility (JH-HLM) scores to objectively measure mobility. Reduced mobility was defined as JH-HLM scores ≤3 over ≥3 consecutive days. The study evaluated the association between reduced mobility and hospital-acquired venous thromboembolism using multivariable logistic regression, comparing admitting health care professional assessments with JH-HLM scores. Symptomatic, hospital-acquired thromboembolisms were diagnosed radiographically by treating providers.

Results: Of 1715 patients, 33 (1.9%) developed venous thromboembolism. Reduced mobility, as determined by the JH-HLM scores, showed a significant association with thromboembolic events (adjusted OR: 2.53, 95%CI:1.23-5.22, P = .012). In contrast, the initial Padua assessment of expected reduced mobility at admission did not. The JH-HLM identified 19.1% of patients as having reduced mobility versus 6.5% by admitting health care professionals, suggesting 37 high-risk patients were misclassified as low risk and were not prescribed thrombosis prophylaxis; 4 patients developed thromboembolic events. JH-HLM detected reduced mobility in 36% of thromboembolic cases, compared to 9% by admitting health care professionals.

Conclusion: Initial mobility evaluations by admitting health care professionals during venous thromboembolism risk assessment may not reflect patient mobility over their hospital stay. This highlights the need for objective measures like JH-HLM in risk assessments to improve accuracy and potentially reduce thromboembolism incidents.

Keywords: Patient mobility; Risk assessment; Venous thromboembolism.