Background: Half of all venous thromboembolic events relate to recent hospitalisation. These events are potentially preventable, through risk assessment and thromboprophylaxis. The majority of UK NHS hospitals use the Risk Assessment Model (RAM) proposed by the Department of Health, derived through expert consensus. It is unclear whether this tool has good inter-rater reliability or is completed accurately within a pragmatic setting.
Aims: We sought to evaluate the inter-rater reliability of the Department of Health RAM within a cohort of acute medical and surgical patients requiring emergency hospitalisation.
Methods: A single centre prospective observational cohort study, conducted during 2020 within a convenience sample of general medical and surgical patients requiring emergency hospitalisation. All patients underwent VTE risk assessment conducted by clinical teams during routine care. Risk assessment was subsequently repeated by trained research assistants within 24h of admission, blinded to the original evaluation. All research assistants underwent standardised VTE risk assessment training.
A minimum sample size of 194 patients was predetermined. We used Cohen’s Kappa as a measure of inter-rater reliability.
Results: During the study period, our observer team repeated 274 risk assessments. We excluded 38 cases classed as medical patients with no mobility restriction. 236 patient episodes with a completed clinical and research assistant risk assessment profile were analysed. 137 (58.1%) patients were hospitalised for medical reasons, and the remaining 99 (41.9%) for surgical reasons.
Our results show substantial inter-observer agreement for the Department of Health tool when used in acute medical admissions (Cohen’s Kappa 0.75 [95% CI 0.64 to 0.86]) but only moderate agreement (0.56 [95% CI 0.36 to 0.75]) for surgical admissions. The reliability of individual risk components was highly variable, with inter-rater agreement ranging from 0.49 to 1.00
Conclusion(s): These findings suggest decision making on pharmacological prophylaxis may vary between clinicians for the same patient, despite the use of a national RAM.
To cite this abstract in AMA style:Horner D, Daniels B, Holland M, Goodacre S, Hunt B, de Wit K. Inter-rater reliability of the UK Department of Health VTE risk assessment tool for medical and surgical hospital admissions [abstract]. https://abstracts.isth.org/abstract/inter-rater-reliability-of-the-uk-department-of-health-vte-risk-assessment-tool-for-medical-and-surgical-hospital-admissions/. Accessed August 16, 2022.
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