DEVELOPMENT AND INTERNAL VALIDATION OF A SCORING PROGNOSTIC MODEL FOR VENOUS THROMBOEMBOLIC COMPLICATIONS IN MAJOR BONE FRACTURES

Introduction: Venous thromboembolic complications (VTEC) pose a serious threat to patients with major skeletal fractures (pelvis, femur, tibia/fibula). The incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in this group reaches 18–50% depending on the severity of trauma, while post-traumatic VTEC remain one of the leading causes of mortality in orthopedics. Due to the absence of standardized protocols for prediction and prevention of VTEC in severe trauma, the development of a specialized prognostic model has become an urgent task. Objective: To develop a scoring model for individualized risk assessment of VTEC in patients with major bone fractures and to perform its internal validation. Methods: A retrospective study included 284 patients (2018–2022) with pelvic fractures (n=94), femoral fractures (n=97), or tibial/fibular fractures (n=93). The occurrence of DVT/PE was considered as the outcome. Significant clinical-anatomical and laboratory predictors of complications were identified using multivariate analysis, assigned weight coefficients, and integrated into a prognostic score. The model was tested on the same cohort: sensitivity, specificity, predictive values were calculated, and the ROC curve was constructed. Results: The developed scale incorporates an integral risk score R, summarizing the contribution of several factors. At R≥7 points (moderate+high risk), the model showed high sensitivity (~95%) for detecting VTEC and a high negative predictive value (>98%), while at R≥16 (high risk) it demonstrated high specificity (~90%) and a positive predictive value (~75%). Validation confirmed effective stratification: the proportion of VTEC was ~2.5% in the low-risk group and increased to ~67% in the high-risk group. The area under the ROC curve reached ~0.90, reflecting high discriminatory ability. Conclusion: The proposed scoring model successfully stratifies patients with major bone fractures by VTEC risk. Internal validation confirmed its reliability: the model enables early identification of high-risk patients requiring enhanced prophylaxis and helps avoid unnecessary interventions in low-risk patients.