Accuracy of efficient data methods to determine the incidence of hospital-acquired thrombosis and major bleeding in medical and surgical inpatients: a multicentre observational cohort study in four UK hospitals.

Objectives: We evaluated the accuracy of using routine health service data to identify hospital-acquired thrombosis (HAT) and major bleeding events (MBE) compared with a reference standard of case note review.
Design: A multicentre observational cohort study.
Setting: Four acute hospitals in the UK.
Participants: A consecutive unselective cohort of general medical and surgical patients requiring hospitalisation for a period of >24 hours during the calendar year 2021. We excluded paediatric, obstetric and critical care patients due to differential risk profiles.
Interventions: We compared preidentified sources of routinely collected information (using hospital coding data and local contractually mandated thrombosis datasets) to data extracted from case notes using a predesigned workflow methodology.
Primary and Secondary Outcome Measures: We defined HAT as objectively confirmed venous thromboembolism occurring during hospital stay or within 90 days of discharge and MBE as per international consensus.
Results: We were able to source all necessary routinely collected outcome data for 87% of 2008 case episodes reviewed. The sensitivity of hospital coding data (International Classification of Diseases 10th Revision, ICD-10) for the diagnosis of HAT and MBE was 62% (95% CI, 54 to 69) and 38% (95% CI, 27 to 50), respectively. Sensitivity improved to 81% (95% CI, 75 to 87) when using local thrombosis data sets.
Conclusions: Using routinely collected data appeared to miss a substantial proportion of outcome events, when compared with case note review. Our study suggests that currently available routine data collection methods in the UK are inadequate to support efficient study designs in venous thromboembolism research.
Trial Registration Number: NIHR127454.
Competing Interests: Competing interests: During the completion of this study, SG, DH, CR, BJH, MBu and MB received funding from the National Institute of Health Research (NIHR) for academic work in this area, through competitive grant application and CR was appointed to an NIHR doctoral research fellow position. Following the completion of this study, CR has been subsequently employed by Pfizer limited. Pfizer did not fund nor support this study and was not involved in drafting or revising this manuscript.
(© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)