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‘Hospice inpatient deep vein thrombosis detection (HIDDen) in advanced non-malignant diseases’: a longitudinal pilot study
  1. Clare White1,2,
  2. Simon Noble3,
  3. Flavia Swan4,
  4. Max Watson5,
  5. Victoria Allgar6,
  6. Eoin Napier7,
  7. Annmarie Nelson3 and
  8. Miriam J Johnson4
  1. 1Northern Ireland Hospice, Belfast, UK
  2. 2Palliative Medicine, Mater Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
  3. 3Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, South Glamorgan, UK
  4. 4Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, Kingston upon Hull, UK
  5. 5Project ECHO, Hospice UK, London, UK
  6. 6Wolfson Palliative Care Research Centre, Hull York Medical School, University of York, York, UK
  7. 7Department of Radiology, Belfast Health and Social Care Trust, Belfast, United Kingdom
  1. Correspondence to Dr Clare White, Northern Ireland Hospice, Belfast, UK; cwhite{at}nihospice.org

Abstract

Objectives To gain preliminary data regarding the prevalence of proximal deep vein thrombosis (DVT) in those with non-malignant conditions admitted to specialist palliative care units (SPCUs).

Methods Data were collected as part of a prospective longitudinal observational study in five SPCUs in England, Wales and Northern Ireland (Registration: ISRCTN97567719) to estimate the prevalence of proximal femoral vein DVT in people admitted to SPCUs. The primary outcome for this exploratory substudy was the prevalence of DVT in patients with non-malignant palliative conditions. Consecutive consenting adults underwent bilateral femoral vein ultrasonography within 48 hours of admission. Data were collected on symptoms associated with venous thromboembolism. Patients were ineligible if the estimated prognosis was <5 days. Cross-sectional descriptive analysis was conducted on baseline data and prevalence estimates presented with 95% CIs.

Results 1390 patients were screened, 28 patients had non-malignant disease and all were recruited. The mean age 68·8 (SD 12·0), range 43–86 years; men 61%; survival mean 86 (SD 108.5) range 1–345 days. No patient had a history of venous thromboembolism. Four (14%) were receiving thromboprophylaxis. Of 22 evaluable scans, 8 (36%, 95% CI: 17% to 59%) showed femoral vein DVT. The level of reported relevant symptoms (leg oedema, leg pain, chest pain and breathlessness) was high irrespective of the presence of DVT.

Conclusions Our exploratory data indicate one in three people admitted to an SPCU with non-malignant disease had a femoral vein DVT. Although definitive conclusions cannot be drawn, these data justify a larger prospective survey.

  • venous thromboembolism
  • non-malignant
  • hospices
  • palliative care
  • thromboprophylaxis
  • DVT
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Footnotes

  • Twitter @annmarienelson0, @MJJohnson_HYMS

  • Contributors Concept: CW, MJJ, SN, MW. Design: CW, MJJ, SN, MW, AN, EN, VA. Data collection and management; FS, VA, MJJ, CW, SN, EN. Radiological review and training: EN, MW. Patient and public involvement leads: AN, SN. Data analysis: FS, VA. First draft of manuscript: CW. Critical revision of manuscript: CW, MJJ, VA, FS. Contribution to and approval of final manuscript: all authors. MJ, VA and FS had access to all raw data. EN had access to all scan images.

  • Funding This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0614-34007). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funder had no role in study design, data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all the data in the study and has final responsibility for the decision to submit for publication. SN and AN’s posts are funded by Marie Curie core grant funding (grant reference MCCC-FCO-17-C).

  • Competing interests MW designed and teaches the Focussed Abdominal Ultrasound in Palliative Care training programme, running since 2007, which trained the research nurses for this study. SN has received speakers bureau fees from Pfizer, Daiichi Sankyo, Bayer and Advisory Board fees from Daiichi Sankyo.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request.

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