Cohort study of prediction of venous thromboembolism in emergency department patients with extremity symptoms.

Cohort study of prediction of venous thromboembolism in emergency department patients with extremity symptoms. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cohort study of prediction of venous thromboembolism in emergency department patients with extremity symptoms. Anders Gottsäter, Ulf Ekelund, Olle Melander, Anders Björkelund, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4043838/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Despite diagnostic algorithms, the best pathway to identify venous thromboembolism (VTE) in emergency departments (ED) needs to be defined. We evaluated symptoms, background, and laboratory data in 27,647 ED patients presenting with pain, swelling, or other symptoms from the extremities, and identified predictors of VTE diagnosis within one year. Predictors of a clinical decision to perform phlebography, ultrasound, or computer tomography (CT) angiography of pelvic, lower, or upper extremity veins, CT of pulmonary arteries, or pulmonary scintigraphy at the ED or within 30 days, and the results of such investigations were also evaluated. A total of 3,195 patients (11.6%) were diagnosed with VTE within one year. In adjusted analysis of patients in whom all laboratory data were available, a d-dimer value ≥0.5 mg/l (odds ratio [OR]: 2.602; 95% confidence interval [CI]: 1.894-3.575; p<0.001) at the ED and a previous diagnosis of VTE (OR: 6.037; CI: 4.465-8.162; p<0.001) independently predicted VTE. Of diagnosed patients, 2,355 (73.7%) had undergone imaging within 30 days after the ED visit and 1,730 (54.1%) were diagnosed at this examination. Lower age (OR: 0.984; CI: 0.972-0.997; p=0.014), higher blood hemoglobin (OR: 1.023; CI: 1.010-1.037; p<0.001), C-reactive protein (OR: 2.229; CI: 1.433-3.468; p<0.001), d-dimer (OR: 8.729; CI: 5.614-13.574; p<0.001), and previous VTE (OR: 7.796; CI: 5.193-11.705; p<0.001) predicted VTE on imaging. In conclusion, analysis of 27,647 ED patients with extremity symptoms confirmed the importance of well-established risk factors for VTE. Many patients developing VTE within one year had initial negative imaging, highlighting the importance of continued symptom vigilance. Venous thromboembolism deep vein thrombosis pulmonary embolism prediction Full Text Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 26 Apr, 2024 Reviewers invited by journal 25 Apr, 2024 Editor assigned by journal 12 Mar, 2024 First submitted to journal 11 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4043838","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":295552045,"identity":"ab52a14c-4265-470e-a2b7-af1bb41724ba","order_by":0,"name":"Anders Gottsäter","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0003-0865-0000","institution":"Lund University: Lunds Universitet","correspondingAuthor":true,"prefix":"","firstName":"Anders","middleName":"","lastName":"Gottsäter","suffix":""},{"id":295552046,"identity":"ed1f09b5-202b-40ec-9880-71132705e225","order_by":1,"name":"Ulf Ekelund","email":"","orcid":"","institution":"Lund University: Lunds Universitet","correspondingAuthor":false,"prefix":"","firstName":"Ulf","middleName":"","lastName":"Ekelund","suffix":""},{"id":295552047,"identity":"02a32342-8a49-45c2-93c8-b50409257c66","order_by":2,"name":"Olle Melander","email":"","orcid":"","institution":"Lund University: Lunds Universitet","correspondingAuthor":false,"prefix":"","firstName":"Olle","middleName":"","lastName":"Melander","suffix":""},{"id":295552048,"identity":"14e0a352-bb15-4f12-b2e0-e782602b0a83","order_by":3,"name":"Anders Björkelund","email":"","orcid":"","institution":"Lund University: Lunds Universitet","correspondingAuthor":false,"prefix":"","firstName":"Anders","middleName":"","lastName":"Björkelund","suffix":""},{"id":295552049,"identity":"dbe86d61-e411-4a72-8bdb-817f0de31f8a","order_by":4,"name":"Bodil Ohlsson","email":"","orcid":"","institution":"Lund University: Lunds Universitet","correspondingAuthor":false,"prefix":"","firstName":"Bodil","middleName":"","lastName":"Ohlsson","suffix":""}],"badges":[],"createdAt":"2024-03-08 12:56:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4043838/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4043838/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55699369,"identity":"55a465cc-59d0-428e-9428-4c221206306f","added_by":"auto","created_at":"2024-05-02 02:44:49","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":350166,"visible":true,"origin":"","legend":"","description":"","filename":"GottsateretalManuscriptfile.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4043838/v1_covered_cfb97d01-c274-4e77-b74f-408ef386f733.pdf"}],"financialInterests":"","formattedTitle":"Cohort study of prediction of venous thromboembolism in emergency department patients with extremity symptoms.","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"internal-and-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"iaem","sideBox":"Learn more about [Internal and Emergency Medicine](http://link.springer.com/journal/11739)","snPcode":"11739","submissionUrl":"https://www.editorialmanager.com/iaem/default.aspx","title":"Internal and Emergency Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Venous thromboembolism, deep vein thrombosis, pulmonary embolism, prediction","lastPublishedDoi":"10.21203/rs.3.rs-4043838/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4043838/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDespite diagnostic algorithms, the best pathway to identify venous thromboembolism (VTE) in emergency departments (ED) needs to be defined. We evaluated symptoms, background, and laboratory data in 27,647 ED patients presenting with pain, swelling, or other symptoms from the extremities, and identified predictors of VTE diagnosis within one year. Predictors of a clinical decision to perform phlebography, ultrasound, or computer tomography (CT) angiography of pelvic, lower, or upper extremity veins, CT of pulmonary arteries, or pulmonary scintigraphy at the ED or within 30 days, and the results of such investigations were also evaluated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA total of 3,195 patients (11.6%) were diagnosed with VTE within one year. In adjusted analysis of patients in whom all laboratory data were available, a d-dimer value ≥0.5 mg/l (odds ratio [OR]: 2.602; 95% confidence interval [CI]: 1.894-3.575; p\u0026lt;0.001) at the ED and a previous diagnosis of VTE (OR: 6.037; CI: 4.465-8.162; p\u0026lt;0.001) independently predicted VTE. Of diagnosed patients, 2,355 (73.7%) had undergone imaging within 30 days after the ED visit and 1,730 (54.1%) were diagnosed at this examination. Lower age (OR: 0.984; CI: 0.972-0.997; p=0.014), higher blood hemoglobin (OR: 1.023; CI: 1.010-1.037; p\u0026lt;0.001), C-reactive protein (OR: 2.229; CI: 1.433-3.468; p\u0026lt;0.001), d-dimer (OR: 8.729; CI: 5.614-13.574; p\u0026lt;0.001), and previous VTE (OR: 7.796; \u0026nbsp;CI: 5.193-11.705; p\u0026lt;0.001) predicted VTE on imaging.\u003c/p\u003e\n\u003cp\u003eIn conclusion, analysis of 27,647 ED patients with extremity symptoms confirmed the importance of well-established risk factors for VTE. Many patients developing VTE within one year had initial negative imaging, highlighting the importance of continued symptom vigilance.\u003c/p\u003e","manuscriptTitle":"Cohort study of prediction of venous thromboembolism in emergency department patients with extremity symptoms.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-02 02:30:53","doi":"10.21203/rs.3.rs-4043838/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2024-04-26T09:50:51+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-25T18:50:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-12T06:21:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Internal and Emergency Medicine","date":"2024-03-12T02:09:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"internal-and-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"iaem","sideBox":"Learn more about [Internal and Emergency Medicine](http://link.springer.com/journal/11739)","snPcode":"11739","submissionUrl":"https://www.editorialmanager.com/iaem/default.aspx","title":"Internal and Emergency Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"f6b4b328-9d32-4845-8686-81daf9deebc7","owner":[],"postedDate":"May 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-06-25T09:19:36+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-02 02:30:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4043838","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4043838","identity":"rs-4043838","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}