Performance Of Risk Assessment Tools Research Articles

Primary Prevention of Cancer-Associated Thrombosis: Current Perspectives.

Over the past two decades, the incidence of cancer-associated thrombosis (CAT) has increased. It is nowadays a common and often serious complication among patients with cancer. Although medical thromboprophylaxis is recommended for most surgical and nonsurgical cancer patients, it has been infrequently used in ambulatory patients with cancer because of the burden of treatment and concerns about bleeding. However, various risk assessment scores are now available and randomized placebo-controlled trials have established the efficacy of low-molecular-weight heparin or the direct oral Xa inhibitors rivaroxaban and apixaban in ambulatory patients with cancer at high risk of venous thromboembolism (VTE). This review provides an overview of (1) primary thromboprophylaxis in the setting of hospitalized surgical and medical patients, (2) extended thromboprophylaxis after hospital discharge, (3) performance of risk assessment tools for CAT, and (4) primary thromboprophylaxis in ambulatory patients with cancer. The aim is to provide support to physicians in identifying ambulatory patients with cancer at high VTE risk who benefit most from medical thromboprophylaxis according to current recommendations from international guidelines.

Violence risk assessment instruments in forensic psychiatric populations: a systematic review and meta-analysis

Although structured tools have been widely used to predict violence risk in specialist mental health settings, there is uncertainty about the extent and quality of evidence of their predictive performance. We aimed to systematically review the predictive performance of tools used to assess violence risk in forensic mental health, where they are routinely administered. In our systematic review and meta-analysis, we followed PRISMA guidelines and searched four databases (PsycINFO, Embase, Medline, and Global Health) from database inception to Nov 1, 2022, to identify studies examining the predictive performance of risk assessment tools in people discharged from forensic (secure) mental health hospitals. Systematic and narrative reviews were excluded from the review. Performance measures and descriptive statistics were extracted from published reports. A quality assessment was performed for each study using the Prediction Model Risk of Bias Assessment Tool. Meta-analysis was conducted on the performance of instruments that were independently externally validated with a sample size greater than 100. The study was registered with PROSPERO, CRD42022304716. We conducted a systematic review of 50 eligible publications, assessing the predictive performance of 36 tools, providing data for 10 460 participants (88% men, 12% women; median age [from 47 studies] was 35 years, IQR 33-38) from 12 different countries. Post-discharge interpersonal violence and crime was most often measured by new criminal offences or recidivism (47 [94%] of 50 studies); only three studies used informant or self-report data on physical aggression or violent behaviour. Overall, the predictive performance of risk assessment tools was mixed. Most studies reported one discrimination metric, the area under the receiver operating characteristic curve (AUC); other key performance measures such as calibration, sensitivity, and specificity were not presented. Most studies had a high risk of bias (49 [98%] of 50), partly due to poor analytical approaches. A meta-analysis was conducted for violent recidivism on 29 independent external validations from 19 studies with at least 100 patients. Pooled AUCs for predicting violent outcomes ranged from 0·72 (0·65-0·79; I2=0%) for H10, to 0·69 for the Historical Clinical Risk Management-20 version 2 (95% CI 0·65-0·72; I2=0%) and Violence Risk Appraisal Guide (0·63-0·75; I2=0%), to 0·64 for the Static-99 (0·53-0·73; I2=45%). Current violence risk assessment tools in forensic mental health have mixed evidence of predictive performance. Forensic mental health services should review their use of current risk assessment tools and consider implementing those with higher-quality evidence in support. Wellcome Trust.

World Health Organization fracture risk assessment tool in the assessment of fractures after falls in hospital

BackgroundFalls are very common accidents in a hospital. Various risk factors and risk assessment tools are used to predict falls. However, outcomes of falls such as bone fractures have not been considered in these risk assessment tools, and the performance of risk assessment tools in a Japanese hospital setting is not clear.MethodsThis was a retrospective single-institution study of 20,320 inpatients aged from 40 to 90 years who were admitted to a tertiary-care university hospital during the period from April 2006 to March 2009. Possible risk factors for falls and fractures including STRATIFY score and FRAX™ score and information on falls and their outcome were obtained from the hospital information system. The datasets were divided randomly into a development dataset and a test dataset. The chi-square test, logistic regression analysis and survival analysis were used to identify risk factors for falls and fractures after falls.ResultsFallers accounted for 3.1% of the patients in the development dataset and 3.5% of the patients in the test dataset, and 2.6% and 2.9% of the fallers in those datasets suffered peripheral fractures. Sensitivity and specificity of the STRATIFY score to predict falls were not optimal. Most of the known risk factors for falls had no power to predict fractures after falls. Multiple logistic analysis and multivariate Cox's regression analysis with time-dependent covariates revealed that FRAX™ score was significantly associated with fractures after falls.ConclusionsRisk assessment tools for falls are not appropriate for predicting fractures after falls. FRAX™ might be a useful tool for that purpose. The performance of STRATIFY to predict falls in a Japanese hospital setting was similar to that in previous studies.