The HIT Expert Probability (HEP) Score: a novel pre-test probability model for heparin-induced thrombocytopenia based on broad expert opinion

被引:186
作者
Cuker, A. [1 ]
Arepally, G. [2 ]
Crowther, M. A. [3 ]
Rice, L. [4 ]
Datko, F. [1 ]
Hook, K. [1 ]
Propert, K. J. [1 ]
Kuter, D. J. [5 ]
Ortel, T. L. [2 ]
Konkle, B. A. [6 ]
Cines, D. B. [1 ]
机构
[1] Univ Penn, Philadelphia, PA 19104 USA
[2] Duke Univ, Durham, NC USA
[3] McMaster Univ, Hamilton, ON, Canada
[4] Weill Cornell Med Coll, Houston, TX USA
[5] Massachusetts Gen Hosp, Boston, MA 02114 USA
[6] Puget Sound Blood Ctr, Seattle, WA 98104 USA
关键词
clinical prediction rule; clinical scoring model; diagnosis; heparin-induced thrombocytopenia; MOLECULAR-WEIGHT HEPARIN; OPTICAL-DENSITY VALUES; 4TS SCORE; DIAGNOSIS; THROMBOSIS; ANTIBODIES; LEPIRUDIN; RISK;
D O I
10.1111/j.1538-7836.2010.04059.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The diagnosis of heparin-induced thrombocytopenia (HIT) is challenging. Over-diagnosis and over-treatment are common. Objectives: To develop a pre-test clinical scoring model for HIT based on broad expert opinion that may be useful in guiding clinical decisions regarding therapy. Patients/methods: A pre-test model, the HIT Expert Probability (HEP) Score, was constructed based on the opinions of 26 HIT experts. Fifty patients referred to a reference laboratory for HIT testing comprised the validation cohort. Two hematology trainees scored each patient using the HEP Score and a previously published clinical scoring system (4 T's). A panel of three independent experts adjudicated the 50 patients and rendered a diagnosis of HIT likely or unlikely. All subjects underwent HIT laboratory testing with a polyspecific HIT ELISA and serotonin release assay (SRA). Results: The HEP Score exhibited significantly greater interobserver agreement [intraclass correlation coefficient: 0.88 (95% CI 0.80-0.93) vs. 0.71 (0.54-0.83)], correlation with the results of HIT laboratory testing and concordance with the diagnosis of the expert panel (area under receiver-operating curve: 0.91 vs. 0.74, P = 0.017) than the 4 T's. The model was 100% sensitive and 60% specific for determining the presence of HIT as defined by the expert panel and would have allowed for a 41% reduction in the number of patients receiving a direct thrombin inhibitor (DTI). Conclusion: The HEP Score is the first pre-test clinical scoring model for HIT based on broad expert opinion, exhibited favorable operating characteristics and may permit clinicians to confidently reduce use of alternative anticoagulants. Prospective multicenter validation is warranted.
引用
收藏
页码:2642 / 2650
页数:9
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