Tags

Type your tag names separated by a space and hit enter

Assessment of deep vein thrombosis or pulmonary embolism by the combined use of clinical model and noninvasive diagnostic tests.
Semin Thromb Hemost. 2000; 26(6):643-56.ST

Abstract

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are relatively common diseases and are amenable to therapy but with a potentially fatal outcome if untreated. The diagnosis can be made in most patients with use of the noninvasive imaging tests, but limitations exist. The standard first choice of investigation in patients with suspected DVT is compression ultrasonography (CUS). As with all tests, there is a potential for false-positive and false-negative results. The latter are especially an issue for calf vein thrombi, and this in part has led to the concept of serial CUS testing of the proximal venous system and not imaging of the calf. The premise of the repeat (serial) CUS test is that only thrombi that extend to the proximal system are clinically relevant, and these thrombi will be detected during subsequent testing. However, despite the safety of the serial CUS testing concept, it is inconvenient and expensive. The standard first choice of investigation in patients with suspected PE, the ventilation-perfusion (V/Q) lung scan is nondiagnostic in most cases. In the past few years, the diagnostic process has improved because of the validation of clinical models that accurately categorize patients as having low (5%), moderate (20% to 30%), or high probability (>60%) for venous thromboembolic disease. Among the improvements this provides is the elimination of serial CUS testing if the ultrasound results are normal and the clinical probability is low in patients with suspected DVT. In patients with suspected PE in whom further testing is necessary, determination of clinical probability allows selection of invasive (angiography) or noninvasive testing (serial ultrasound) in patients with non-high-probability V/Q scans. The fibrin degradation product D-dimer has had a high negative predictive value; negative results with enzyme-linked immunosorbent assay (ELISA) tests effectively rule out DVT or PE. In addition, a negative result with less-sentive D-dimer testing and a low clinical probability excludes DVT or PE.

Authors+Show Affiliations

Department of Medicine, Ottawa Hospital and the University of Ottawa, Ontario, Canada. pwells@ottawahospital.on.caNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

11140801

Citation

Wells, P S., et al. "Assessment of Deep Vein Thrombosis or Pulmonary Embolism By the Combined Use of Clinical Model and Noninvasive Diagnostic Tests." Seminars in Thrombosis and Hemostasis, vol. 26, no. 6, 2000, pp. 643-56.
Wells PS, Anderson DR, Ginsberg J. Assessment of deep vein thrombosis or pulmonary embolism by the combined use of clinical model and noninvasive diagnostic tests. Semin Thromb Hemost. 2000;26(6):643-56.
Wells, P. S., Anderson, D. R., & Ginsberg, J. (2000). Assessment of deep vein thrombosis or pulmonary embolism by the combined use of clinical model and noninvasive diagnostic tests. Seminars in Thrombosis and Hemostasis, 26(6), 643-56.
Wells PS, Anderson DR, Ginsberg J. Assessment of Deep Vein Thrombosis or Pulmonary Embolism By the Combined Use of Clinical Model and Noninvasive Diagnostic Tests. Semin Thromb Hemost. 2000;26(6):643-56. PubMed PMID: 11140801.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of deep vein thrombosis or pulmonary embolism by the combined use of clinical model and noninvasive diagnostic tests. AU - Wells,P S, AU - Anderson,D R, AU - Ginsberg,J, PY - 2001/1/5/pubmed PY - 2001/4/6/medline PY - 2001/1/5/entrez SP - 643 EP - 56 JF - Seminars in thrombosis and hemostasis JO - Semin. Thromb. Hemost. VL - 26 IS - 6 N2 - Deep vein thrombosis (DVT) and pulmonary embolism (PE) are relatively common diseases and are amenable to therapy but with a potentially fatal outcome if untreated. The diagnosis can be made in most patients with use of the noninvasive imaging tests, but limitations exist. The standard first choice of investigation in patients with suspected DVT is compression ultrasonography (CUS). As with all tests, there is a potential for false-positive and false-negative results. The latter are especially an issue for calf vein thrombi, and this in part has led to the concept of serial CUS testing of the proximal venous system and not imaging of the calf. The premise of the repeat (serial) CUS test is that only thrombi that extend to the proximal system are clinically relevant, and these thrombi will be detected during subsequent testing. However, despite the safety of the serial CUS testing concept, it is inconvenient and expensive. The standard first choice of investigation in patients with suspected PE, the ventilation-perfusion (V/Q) lung scan is nondiagnostic in most cases. In the past few years, the diagnostic process has improved because of the validation of clinical models that accurately categorize patients as having low (5%), moderate (20% to 30%), or high probability (>60%) for venous thromboembolic disease. Among the improvements this provides is the elimination of serial CUS testing if the ultrasound results are normal and the clinical probability is low in patients with suspected DVT. In patients with suspected PE in whom further testing is necessary, determination of clinical probability allows selection of invasive (angiography) or noninvasive testing (serial ultrasound) in patients with non-high-probability V/Q scans. The fibrin degradation product D-dimer has had a high negative predictive value; negative results with enzyme-linked immunosorbent assay (ELISA) tests effectively rule out DVT or PE. In addition, a negative result with less-sentive D-dimer testing and a low clinical probability excludes DVT or PE. SN - 0094-6176 UR - https://www.unboundmedicine.com/medline/citation/11140801/Assessment_of_deep_vein_thrombosis_or_pulmonary_embolism_by_the_combined_use_of_clinical_model_and_noninvasive_diagnostic_tests_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2000-13219 DB - PRIME DP - Unbound Medicine ER -