A systematic review of clinical prediction scores for deep vein thrombosis

2016 ◽  
Vol 32 (8) ◽  
pp. 516-531 ◽  
Author(s):  
Marina Kafeza ◽  
Joseph Shalhoub ◽  
Nina Salooja ◽  
Lucy Bingham ◽  
Konstantina Spagou ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
A Priori ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Clinical Score ◽  
Detailed Knowledge ◽  
Clinical Prediction ◽  
Diagnostic Score ◽  
Vein Thrombosis ◽  
Deep Vein

Objective Diagnosis of deep vein thrombosis remains a challenging problem. Various clinical prediction rules have been developed in order to improve diagnosis and decision making in relation to deep vein thrombosis. The purpose of this review is to summarise the available clinical scores and describe their applicability and limitations. Methods A systematic search of PubMed, MEDLINE and EMBASE databases was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance using the keywords: clinical score, clinical prediction rule, risk assessment, clinical probability, pretest probability, diagnostic score and medical Subject Heading terms: ‘Venous Thromboembolism/diagnosis’ OR ‘Venous Thrombosis/diagnosis’. Both development and validation studies were eligible for inclusion. Results The search strategy returned a total of 2036 articles, of which 102 articles met a priori criteria for inclusion. Eight different diagnostic scores were identified. The development of these scores differs in respect of the population included (hospital inpatients, hospital outpatients or primary care patients), the exclusion criteria, the inclusion of distal deep vein thrombosis and the use of D-dimer. The reliability and applicability of the scores in the context of specific subgroups (inpatients, cancer patients, elderly patients and those with recurrent deep vein thrombosis) remains controversial. Conclusion Detailed knowledge of the development of the various clinical prediction scores for deep vein thrombosis is essential in understanding the power, generalisability and limitations of these clinical tools.

Accuracy and usefulness of a clinical prediction rule and D-dimer testing in excluding deep vein thrombosis in cancer patients

2008 ◽  
Vol 123 (1) ◽  
pp. 177-183 ◽  
Author(s):  
Marc Carrier ◽  
Agnes Y.Y. Lee ◽  
Shannon M. Bates ◽  
David R Anderson ◽  
Philip S. Wells
Keyword(s):  
Deep Vein Thrombosis ◽  
Cancer Patients ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Clinical Prediction ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
D Dimer

Evidence for Safe Exclusion of Deep Vein Thrombosis (DVT) by a Rapid ELISA D-Dimeer Test at Cut-Off Levels of 500 and 1000 Ng/Ml in 1046 Consecutive Outpatients with Suspected DVT.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1059-1059
Author(s):  
Jan Jacques Michels ◽  
Jan Hermssen ◽  
Paul H. Trienekens
Keyword(s):  
Deep Vein Thrombosis ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Clinical Score ◽  
Large Prospective Study ◽  
Vein Thrombosis ◽  
Persistent Symptoms ◽  
Deep Vein ◽  
D Dimer ◽  
Compression Ultrasonography

Abstract Introduction.A normal compression ultrasonography (CUS) safely excludes proximal deep vein thrombosis (DVT) with a negative predictive value of 97% indicating the need to repeat CUS testing within one week. In 3 studies, the rapid ELISA D-dimer assay at a cut-off of 500 ng/ml did have a sensitivity of 100% for the exclusion of venographically documented distal and proximal DVT irrespective of clinical score. To test this hypothesis we performed a large prospective study in outpatients with suspected DVT. Methods. CUS and a rapid ELISA D-Dimer test (VIDAS, BioMérieux L’Etoile, France) were performed in patients with suspected DVT. A negative CUS with a D-Dimer result of <500 ng/ml exclude DVT, and with a D-Dimer result of >500 ng/ml was followed by a second CUS within one week. Results. The prevalence of DVT 1046 consecutive out patients with suspected DVT was 23,4%. The first CUS was positive in 228 with a rapid ELISA D-Dimer of >500 ng/ml in 227 and of <500 ng/ml in one case, indicating a sensitivity of 99,6% irrespective of clinical score. The first CUS was negative in 818. The rapid ELISA D-dimer test Was <500 ng/ml in 297 of which 296 had a negative first CUS indicating a negative predictive value of 99.7% at a specificity of 37% irrespective of the clinicl score. The negative predictive value of a negative CUS plus a rapid ELISA D-Dimer result of less than 1000 ng/ml is 99.5% at a specificity of 67,9% irrespective of clinical score. The prevalence of DVT in patients with negative first CUS and a ELISA D-Dimer of >1000 ng/ml was 5.6% as documented by CUS repeat within on week. Conclusion.A normal rapid ELISA D-dimer test, <500 ng/ml, in outpatients with suspected DVT safely excludes DVT irrespective of clinical score. After a negative rapid ELISA result (<500 ng/ml), CUS is still indicated for safety reasons in patients with suspected DVT and persistent symptoms in search for an alternative diagnosis, or for a rare case of DVT. A negative CUS plus and ELISA D-Dimer result of <1000 ng/ml safely exclude DVT without the need to repeat CUS in 2/3 of patients with a negative first CUS.

Accuracy and usefulness of a clinical prediction rule and D-dimer testing in excluding deep vein thrombosis (DVT) in cancer patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19522-19522
Author(s):  
M. Carrier ◽  
A. Lee ◽  
S. Bates ◽  
P. S. Wells
Keyword(s):  
Cancer Patients ◽  
Diagnostic Testing ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Clinical Prediction ◽  
Probability Score ◽  
Vein Thrombosis ◽  
Clinical Probability ◽  
Low Probability ◽  
D Dimer

19522 Background: Cancer patients frequently present with thrombotic complications and rapid, accurate diagnostic testing would reduce morbidity and mortality. Although the combination of a low clinical probability using clinical prediction rules (e.g. Well’s Score) and a negative D-dimer result have proven to be safe and reliable in ruling out DVT in the general population, the accuracy of such a strategy is less certain in cancer patients. Because cancer patients often have alternative reasons for leg swelling and pain, and because malignancy and chemotherapy can render the D-dimer test positive in the absence of DVT, we hypothesize that the Well’s Score and D-dimer testing are potentially less accurate and less useful in excluding DVT in patients with active cancer. Methods: We performed a retrospective analysis of 2 prospective studies to compare the diagnostic test characteristics of the Well’s Score and D-dimer testing between patients with and without cancer presenting with suspected DVT. Results: A total of 1630 patients were studied; 107 had cancer. DVT was confirmed in 39.3% of patients with and 13.7% of patients without cancer. In both patient groups, the proportions of patients with DVT were significantly different among the high-, moderate- and low-probability groups according to the Well’s score (P<0.001). However, significantly fewer cancer patients (19.6%) had a low-probability score compared to patients without cancer (47.5%) (P<0.001). Similarly, 36.4% of cancer vs. 60.4% of noncancer patients had a negative D-dimer result (P<0.001). In cancer patients, a low probability score alone had a sensitivity of 95.2% (95%CI 82.6%-99.2%) and a specificity of 29.2% (95% CI 18.9%-42.0%). In combination with D-dimer testing, the sensitivity improved to 100% (95%CI 31.0%-100%) but the specificity was reduced to 26.4% (95%CI 13.5%-44.7%). In contrast, the specificity in patients without cancer was preserved at 53.9% (95%CI 50.4%-57.3%). Conclusion: DVT can be ruled out in cancer patients with a low clinical probability of DVT and a negative D-dimer result. However, the low specificity of these tests excludes very few patients and thereby limits their clinical usefulness. No significant financial relationships to disclose.

The Phlebographic Distribution of Deep Venous Thrombosis in the Calf and its Relevance to Duplex Ultrasound

1992 ◽  
Vol 7 (2) ◽  
pp. 64-66 ◽  
Author(s):  
M. Lea Thomas ◽  
G. Solis
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Outcome Measures ◽  
Duplex Ultrasound ◽  
Popliteal Vein ◽  
Detailed Knowledge ◽  
Vein Thrombosis ◽  
Deep Vein

Objective: To assess the distribution of deep vein thrombosis in the calf by phlebography. Setting: Department of Vascular Radiology, St. Thomas' Hospital, London, England. Patients: Seventy patients with suspected deep vein thrombosis or pulmonary embolism were examined. Interventions: Bilateral ascending contrast phlebography was performed in all patients. Main Outcome Measures: The sites of any thrombus in the stem or muscle veins of the calf below the popliteal vein were recorded. Results: One hundred legs contained thrombus. In fifty-three legs thrombus was present solely in the calf veins below the popliteal vein. Isolated thrombus in either one or more of the three paired stem veins or the muscle veins was present in twenty-two calves. Conclusions: Because of the difficulty in visualising some calf veins by duplex ultrasound it is suggested that a detailed knowledge of the distribution of thrombus may assist ultrasonographers.

scholarly journals GPs’ familiarity with and use of cardiovascular clinical prediction rules: a UK survey study

BJGP Open ◽  
2020 ◽  
Vol 4 (5) ◽  
pp. bjgpopen20X101081
Author(s):  
Jong-Wook Ban ◽  
Rafael Perera ◽  
Richard Stevens
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Survey Study ◽  
Risk Scores ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Prediction Rules ◽  
Vein Thrombosis ◽  
The Uk ◽  
Deep Vein

BackgroundClinical prediction rules (CPRs) can help general practitioners (GPs) address challenges in cardiovascular disease. A survey published in 2014 evaluated GPs’ awareness and use of CPRs in the UK. However, many new CPRs have been published since and it is unknown which cardiovascular CPRs are currently recognised and used.AimTo identify cardiovascular CPRs recognised and used by GPs, and to assess how GPs’ familiarity and use have changed over time.Design & settingAn online survey of GPs in the UK was undertaken.MethodUsing comparable methods to the 2014 survey, GPs were recruited from a network of doctors in the UK. They were asked how familiar they were with cardiovascular CPRs, how frequently they used them, and why they used them. The results were compared with the 2014 survey.ResultsMost of 401 GPs were familiar with QRISK scores, ABCD scores, CHADS scores, HAS-BLED score, Wells scores for deep vein thrombosis, and Wells scores for pulmonary embolism. The proportions of GPs using these CPRs were 96.3%, 65.1%, 97.3%, 93.0%, 92.5%, and 82.0%, respectively. GPs’ use increased by 31.2% for QRISK scores, by 13.5% for ABCD scores, by 54.6% for CHADS scores, by 33.2% for Wells scores for deep vein thrombosis, and by 43.6% for Wells scores for pulmonary embolism; and decreased by 45.9% for the Joint British Societies (JBS) risk calculator, by 38.7% for Framingham risk scores, and by 8.7% for New Zealand tables. GPs most commonly used cardiovascular CPRs to guide therapy and referral.ConclusionThe study found GPs’ familiarity and use of cardiovascular CPRs changed substantially. Integrating CPRs into guidelines and practice software might increase familiarity and use.

Success Rate Of Fibrinolytic Therapy In Fresh And Old Deep Vein Thrombosis

1981 ◽  
Author(s):  
W Theiss ◽  
A Wirtzfeld ◽  
P Maubach
Keyword(s):  
Deep Vein Thrombosis ◽  
Thrombolytic Therapy ◽  
Venous Thrombosis ◽  
Success Rate ◽  
A Priori ◽  
Fibrinolytic Therapy ◽  
Time Limit ◽  
Vein Thrombosis ◽  
The Third ◽  
Deep Vein

It is still a wide-held belief that fibrinolytic therapy can clear thrombi from deep veins only while they are fresh. We have therefore analysed retrospectively the phlebographic results obtained in 85 patients, all of whom had fibrinolytic therapy for thrombosis of the iliac and/or femoral veins with symptoms present for 1 day to 8 weeks prior to treatment. Streptokinase (n=46), urokinase (n=9), or both drugs successively (n=30) were administered according to our guidelines as recently outlined in detail (Klin. Wschr. 58:521, 1980; Med. Klin. 75:580, 1980) particular emphasis being placed on sufficient duration of thrombolytic therapy with no a priori time limit.Thus, S.C. administration of heparin seems to be as efficient and safe as administration of heparin I.V. in the treatment of patients with acute DVT.The number of cases grouped according to the lenghth of their history and their respective phlebographic outcome as well as the duration of thrombolytic therapy are listed in the table.It can be seen that the success rate was good, when the patient presented with a delay of up to 2 weeks; even during the third or fourth week of the thrombotic episode two thirds of the patients could still be improved. Thereafter the results were uniformly poor.Conclusion: Iliofemoral venous thrombosis can be treated successfully with fibrinolytic drugs for much longer after its onset than is generally accepted.

The role of fibrin monomers in optimizing the diagnostic work-up of deep vein thrombosis

2007 ◽  
Vol 97 (05) ◽  
pp. 807-813 ◽  
Author(s):  
Fred Haas ◽  
Mariette Agterof ◽  
Marike Vos ◽  
Douwe Biesma ◽  
Roger Schutgens
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Score ◽  
Vein Thrombosis ◽  
Clinical Probability ◽  
Diagnostic Work ◽  
Additional Value ◽  
Deep Vein ◽  
Work Up ◽  
Fibrin Monomers ◽  
D Dimer

SummaryDespite the use of a clinical score and D-dimers to exclude deep vein thrombosis (DVT), the majority of patients still need repeated ultrasound (US).The aim of the study was to investigate whether fibrin monomers (FMs), as markers of thrombin generation, have additional value in the diagnosis of DVT. This is a posthoc analysis of 464 outpatients, participants in a management study using D-dimers (Tina-Quant® ) and a clinical score in the exclusion of DVT. Two new FM assays (Auto LIA-FM® and IATRO SF®, Japan) were performed. Overall sensitivity, negative predictive value (NPV) and specificity of the D-dimer test were 98%, 98% and 42%.The optimal cut-off point for the Auto LIAFM test was ≤ 3 µ g/ml with values of 88%, 88% and 59%, respectively. The IATRO SF test had an optimal cut-off point of ≤ 2 µ g/ ml with values of 92%, 81 and 22%, respectively.The NPV of a non-high clinical score and a normal D-dimer (n=97) was 100%. In patients with a high clinical score (n=160), the NPV of the D-dimer was 88%. In these patients, a single US combined with a normal D-dimer or FM test had an equal NPV as serial US (100 versus 98%, respectively) and lead to a reduction in the need for US by 36–53%, respectively. In patients with abnormal D-dimer concentrations (n=343), a normal US combined with a normal Auto LIA-FM test had a NPV of 97%,which was also true for serial US.This could lead to a reduction in the need for US by 45%. The present studied FMs are inferior to theTina-Quant D-dimer test when used as primary screening tool to exclude DVT.Adding these FMs to patients with a normal Tina-Quant D-dimer has no benefit. In patients with a high pretest clinical probability score, a single US in combination with a normal D-dimer or FM test might be as safe as serial US. In patients with abnormal D-dimer concentrations and a normal US, a normal FM test might be able to replace the second US.

Comparison of clinical prediction scores for the diagnosis of deep vein thrombosis in unselected population of outpatients and inpatients

2014 ◽  
Vol 30 (7) ◽  
pp. 469-474 ◽  
Author(s):  
N Sermsathanasawadi ◽  
P Suparatchatpun ◽  
T Pumpuang ◽  
K Hongku ◽  
K Chinsakchai ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Limb ◽  
Clinical Prediction ◽  
Probability Score ◽  
Vein Thrombosis ◽  
Wells Score ◽  
Unselected Population ◽  
Deep Vein ◽  
Compression Ultrasonography

Objectives The aim of this research was to compare the accuracy of the modified Wells, the Wells, the Kahn, the St. André, and the Constans score for the diagnosis of deep vein thrombosis of the lower limb in unselected population of outpatients and inpatients. Method The pretest of probability score was employed in consecutive 500 outpatients and inpatients with suspicion of deep vein thrombosis. All patients were examined with compression ultrasonography. Results Deep vein thrombosis was confirmed in 26.4%. In the unselected population of outpatients and inpatients, the accuracy of the modified Wells score and the Constans score was higher than other scores. Both scores were more accurate for the outpatients. There was no accurate score for the inpatient subgroup. Conclusions The modified Wells and the Constans score appear to be useful in the unselected population of outpatients and inpatients and particularly in the outpatient subgroup.

In proven deep vein thrombosis, a low positive D-Dimer score is a strong negative predictor for associated malignancy

2004 ◽  
Vol 91 (06) ◽  
pp. 1219-1222 ◽  
Author(s):  
Sue Jones ◽  
Jane Day ◽  
Catherine Hoggarth ◽  
Kanchan Rege
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Score ◽  
Vein Thrombosis ◽  
Negative Prediction ◽  
Associated Malignancy ◽  
One Year ◽  
Clinical Conditions ◽  
Deep Vein ◽  
Negative Predictor ◽  
D Dimer

SummaryD-Dimer measurements are being increasingly used for negative prediction of deep vein thrombosis (DVT). At our institution, clinical score, D-Dimer assay, plethysmography and, if necessary, Doppler ultrasound are used to secure the diagnosis. We collected the data from 100 consecutive patients proven to have DVT. We examined their medical case notes at diagnosis for concurrent clinical conditions and one year later to look for documented evidence of malignancy. Twenty-two of the 66 patients with D-Dimers greater than 1000 ng/ml were diagnosed with a cancer compared with only 2 of the 34 patients with a presenting D-Dimer score of less than 1000 ng/ml. We propose that a D-Dimer score of less than 1000 ng/ml in proven DVT is a strong negative predictor for malignancy (p = 0.0025).

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