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Venous Thromboembolism


Form ID: F12
Form Name: Venous Thromboembolism
Version: 1.2
Form Short Name: VTE
Synonym: VTE
Definition: Venous thromboembolism (VTE) comprises one or both of the following: (1) a deep vein thrombosis (DVT) or (2) a pulmonary embolism (PE).
DVT refers to partial or total thrombotic occlusion of a deep vein of the lower extremity or pelvis (e.g., inferior vena cava, iliac, femoral, popliteal, tibial, gastrocnemial, soleal, or peroneal vein) or a deep vein of the upper extremity or upper thorax (e.g., internal jugular, brachiocephalic, superior vena cava, axillary, brachial, or subclavian). Symptomatic DVT is an objectively confirmed DVT that results in symptoms that include pain and/or swelling of the affected limb.
PE refers to a partial or total thromboembolic occlusion of one or more pulmonary arteries that causes symptoms or death. Symptomatic PE is an objectively confirmed PE that results in symptoms or signs such as shortness of breath, pleuritic chest pain, hemoptysis, oxygen desaturation, or death.
"Onset of the VTE incident" refers to the time of the first sign(s) or symptom(s) that leads to the eventual diagnosis and confirmation of the DVT or PE.
Setting: Hospitals, including outpatient pharmacies and outpatient departments located within the hospital
Language: U.S. English
Guide For Use: Use this form to report a deep vein thrombosis (DVT) or a pulmonary embolism (PE) that (1) had onset during this stay; (2) was present on admission but that occurred or developed within 30 days of a prior discharge from this facility; or (3) had onset within 30 days of discharge from this facility.
DVT and PE are two presentations of the same disease: venous thromboembolism (VTE). DVT refers to partial or total thrombotic occlusion of a deep vein of the lower extremity or pelvis (e.g., inferior vena cava, iliac, femoral, popliteal, tibial, gastrocnemial, soleal, or peroneal vein) or a deep vein of the upper extremity or upper thorax (e.g., internal jugular, brachiocephalic, superior vena cava, axillary, brachial, or subclavian). Symptomatic DVT is an objectively confirmed DVT that results in symptoms including pain and/or swelling of the affected limb.
PE refers to a partial or total thromboembolic occlusion of one or more pulmonary arteries that cause symptoms or death. Symptomatic PE is an objectively confirmed PE that results in symptoms or signs such as shortness of breath, pleuritic chest pain, hemoptysis, oxygen desaturation, or death.
"Onset of the VTE incident" refers to the time of the first sign(s) or symptom(s) that leads to the eventual diagnosis and confirmation of the DVT or PE. A VTE that develops between two separate hospital stays at the same facility should only be reported once.
Do not use this form to report the following:
Asymptomatic VTE (i.e., DVT and/or PE identified on screening exam or incidentally);
VTE occurring in a patient receiving palliative or comfort care;
Thrombosis involving another venous system such as intracranial veins or sinuses, or splanchnic, portal or renal veins;
VTE that develops within 48 hours of admission, except if the patient had been discharged from the reporting facility within the prior 30 days;
VTE in a patient admitted to the hospital with a diagnosis of, or suspected diagnosis of, acute DVT or PE, except if discharged from the reporting facility within 30 days of being readmitted to that same facility;
VTE in a patient with prior or chronic VTE who has leg swelling and no documentation of acute changes on ultrasound report;
VTE diagnosed more than 30 days after hospital discharge;
VTE diagnosed based on any one, or any combination of, (1) clinical criteria, (2) D-dimer test results, or (3) imaging test results that are "inconclusive" or are of "low probability";
Superficial vein thrombosis and/or phlebitis that does not extend into a deep vein;
Non-thrombotic emboli (e.g., air, fat, amniotic fluid, or foreign body or material);
Narrative detail can be captured on the Healthcare Event Reporting Form (HERF). Highlighted fields are collected for local facility and PSO use. This information will not be forwarded to the Network of Patient Safety Databases (NPSD).
Comments: None defined at this time
Description Of Change: Not Applicable
Data Element ID Sort Data Element Name Sort Question Number Sort Version Sort Effective Date Sort Until Date Sort
DE1003 VTE type 1 Hospital Version 1.2 04/03/2012 - -
DE1006 DVT location 2 Hospital Version 1.2 04/03/2012 - -
DE1009 DVT confirmation test 3 Hospital Version 1.2 04/03/2012 - -
DE1012 PE confirmation test 4 Hospital Version 1.2 04/03/2012 - -
DE1015 VTE prior risk assessment 5 Hospital Version 1.2 04/03/2012 - -
DE1018 VTE order set 6 Hospital Version 1.2 04/03/2012 - -
DE1021 VTE risk 7 Hospital Version 1.2 04/03/2012 - -
DE1024 Assessed bleeding risk 8 Hospital Version 1.2 04/03/2012 - -
DE1027 VTE physical/mechanical prophylaxis 9 Hospital Version 1.2 04/03/2012 - -
DE1030 VTE pharmacological prophylaxis 10 Hospital Version 1.2 04/03/2012 - -
DE1033 VTE anticoagulant prophylaxis not given 11 Hospital Version 1.2 04/03/2012 - -
Effective Date: 04/01/2012
Until Date: - -
Update Date: 04/24/2013
Submitting Organization: Agency for Healthcare Research and Quality (AHRQ)
Date of Submission: - -
Responsible Organization: Agency for Healthcare Research and Quality (AHRQ)
Creator: Amy Helwig, MD, MS
Data Steward: Agency for Healthcare Research and Quality
References: Not Applicable
Administrative Status: Final
Administrative Status Date: 01/24/2014
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