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Prospective evaluation of a screening protocol to exclude deep vein thrombosis on the basis of a combination of quantitative D-dimer testing and pretest clinical probability score.
J Am Coll Surg. 2005 Nov; 201(5):701-9.JA

Abstract

BACKGROUND

Clinical signs and symptoms such as swelling, pain, and redness are unreliable markers of deep vein thrombosis (DVT). Because of this venous duplex scanning (VDS) has been heavily used in DVT detection. The purpose of this study was to determine if a combination of D-dimer testing and pretest clinical score could reduce the use of VDS in symptomatic patients with suspected DVT.

STUDY DESIGN

One hundred seventy-four consecutive patients with suspected DVT were prospectively evaluated using pretest clinical probability (PCP) score and D-dimer testing before VDS. After calculating clinical probability scores developed by Wells and associates, patients were divided into low risk (<or= 0 points), moderate risk (1 to 2 points), and high risk (>or=3 points) PCP.

RESULTS

One hundred fifty-eight patients were enrolled. The prevalence of DVT in this study was 37%. Thirty-eight patients (24%) were classified as low risk, 64 (41%) as moderate risk, and 56 (35%) as high risk PCP. DVT was identified in only one patient (2.6%) with low risk PCP. In contrast, DVT was found in 22 (34%) with moderate risk, and 35 (63%) with high risk PCP. In the high and moderate risk PCP groups, positive scan patients had a markedly higher value of D-dimer assay than negative scan patients (p=0.0001 and p=0.0057, respectively). In the low risk PCP patients, D-dimer testing provided 100% sensitivity, 46% specificity, 4.8% positive predictive value, and 100% negative predictive value in the diagnosis of DVT. Similarly, in the moderate risk PCP, the D-dimer testing showed 100% sensitivity, 45% specificity, 49% positive predictive value, and 100% negative predictive value. In the high risk group, D-dimer testing achieved 100% sensitivity, 57% specificity, 80% positive predictive value, and 100% negative predictive value in the diagnosis of DVT. These results suggested that 36 of 158 patients who had a non-high PCP (low and moderate PCP) and a normal D-dimer concentration were considered to have no additional investigation, so VDS could have been reduced by 23% (36/158).

CONCLUSIONS

A combination of D-dimer testing and clinical probability score may be effective in avoiding unnecessary VDS in suspected symptomatic DVT in the low and moderate PCP patients. The need for VDS could be reduced by 23% despite a relatively high prevalence of DVT.

Authors+Show Affiliations

Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16256912

Citation

Yamaki, Takashi, et al. "Prospective Evaluation of a Screening Protocol to Exclude Deep Vein Thrombosis On the Basis of a Combination of Quantitative D-dimer Testing and Pretest Clinical Probability Score." Journal of the American College of Surgeons, vol. 201, no. 5, 2005, pp. 701-9.
Yamaki T, Nozaki M, Sakurai H, et al. Prospective evaluation of a screening protocol to exclude deep vein thrombosis on the basis of a combination of quantitative D-dimer testing and pretest clinical probability score. J Am Coll Surg. 2005;201(5):701-9.
Yamaki, T., Nozaki, M., Sakurai, H., Takeuchi, M., Soejima, K., & Kono, T. (2005). Prospective evaluation of a screening protocol to exclude deep vein thrombosis on the basis of a combination of quantitative D-dimer testing and pretest clinical probability score. Journal of the American College of Surgeons, 201(5), 701-9.
Yamaki T, et al. Prospective Evaluation of a Screening Protocol to Exclude Deep Vein Thrombosis On the Basis of a Combination of Quantitative D-dimer Testing and Pretest Clinical Probability Score. J Am Coll Surg. 2005;201(5):701-9. PubMed PMID: 16256912.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective evaluation of a screening protocol to exclude deep vein thrombosis on the basis of a combination of quantitative D-dimer testing and pretest clinical probability score. AU - Yamaki,Takashi, AU - Nozaki,Motohiro, AU - Sakurai,Hiroyuki, AU - Takeuchi,Masaki, AU - Soejima,Kazutaka, AU - Kono,Taro, Y1 - 2005/09/23/ PY - 2004/05/04/received PY - 2005/06/17/revised PY - 2005/06/20/accepted PY - 2005/11/1/pubmed PY - 2005/12/24/medline PY - 2005/11/1/entrez SP - 701 EP - 9 JF - Journal of the American College of Surgeons JO - J. Am. Coll. Surg. VL - 201 IS - 5 N2 - BACKGROUND: Clinical signs and symptoms such as swelling, pain, and redness are unreliable markers of deep vein thrombosis (DVT). Because of this venous duplex scanning (VDS) has been heavily used in DVT detection. The purpose of this study was to determine if a combination of D-dimer testing and pretest clinical score could reduce the use of VDS in symptomatic patients with suspected DVT. STUDY DESIGN: One hundred seventy-four consecutive patients with suspected DVT were prospectively evaluated using pretest clinical probability (PCP) score and D-dimer testing before VDS. After calculating clinical probability scores developed by Wells and associates, patients were divided into low risk (<or= 0 points), moderate risk (1 to 2 points), and high risk (>or=3 points) PCP. RESULTS: One hundred fifty-eight patients were enrolled. The prevalence of DVT in this study was 37%. Thirty-eight patients (24%) were classified as low risk, 64 (41%) as moderate risk, and 56 (35%) as high risk PCP. DVT was identified in only one patient (2.6%) with low risk PCP. In contrast, DVT was found in 22 (34%) with moderate risk, and 35 (63%) with high risk PCP. In the high and moderate risk PCP groups, positive scan patients had a markedly higher value of D-dimer assay than negative scan patients (p=0.0001 and p=0.0057, respectively). In the low risk PCP patients, D-dimer testing provided 100% sensitivity, 46% specificity, 4.8% positive predictive value, and 100% negative predictive value in the diagnosis of DVT. Similarly, in the moderate risk PCP, the D-dimer testing showed 100% sensitivity, 45% specificity, 49% positive predictive value, and 100% negative predictive value. In the high risk group, D-dimer testing achieved 100% sensitivity, 57% specificity, 80% positive predictive value, and 100% negative predictive value in the diagnosis of DVT. These results suggested that 36 of 158 patients who had a non-high PCP (low and moderate PCP) and a normal D-dimer concentration were considered to have no additional investigation, so VDS could have been reduced by 23% (36/158). CONCLUSIONS: A combination of D-dimer testing and clinical probability score may be effective in avoiding unnecessary VDS in suspected symptomatic DVT in the low and moderate PCP patients. The need for VDS could be reduced by 23% despite a relatively high prevalence of DVT. SN - 1072-7515 UR - https://www.unboundmedicine.com/medline/citation/16256912/Prospective_evaluation_of_a_screening_protocol_to_exclude_deep_vein_thrombosis_on_the_basis_of_a_combination_of_quantitative_D_dimer_testing_and_pretest_clinical_probability_score_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1072-7515(05)01044-6 DB - PRIME DP - Unbound Medicine ER -