A simplified decision rule to rule out deep vein thrombosis using clinical assessment and D-dimer
(2021) In Journal of Thrombosis and Haemostasis 19(7). p.1752-1758- Abstract
Background: Current clinical decision rules to exclude deep vein thrombosis (DVT) are underused partly because of their complexity. A simplified rule that can be easily applied would be more appealing to use in clinical practice. Methods: We used individual patient data from prospective diagnostic studies of patients suspected of DVT to develop a new clinical decision rule. The primary outcome was presence of DVT either at initial testing or during follow-up. DVT was considered safely excluded if the upper 95% confidence interval (CI) of DVT prevalence was <2%. Results: Four studies and 3368 patients were eligible for this analysis. Overall prevalence of DVT was 17%. In addition to D-dimer, two variables, calf swelling and DVT as the... (More)
Background: Current clinical decision rules to exclude deep vein thrombosis (DVT) are underused partly because of their complexity. A simplified rule that can be easily applied would be more appealing to use in clinical practice. Methods: We used individual patient data from prospective diagnostic studies of patients suspected of DVT to develop a new clinical decision rule. The primary outcome was presence of DVT either at initial testing or during follow-up. DVT was considered safely excluded if the upper 95% confidence interval (CI) of DVT prevalence was <2%. Results: Four studies and 3368 patients were eligible for this analysis. Overall prevalence of DVT was 17%. In addition to D-dimer, two variables, calf swelling and DVT as the most likely diagnosis, are included in the new rule. Based on these two variables, two clinical pretest probability (CPTP) groups were defined; low (none of the two items present) and high (at least one of the items present). DVT can be safely excluded in patients with low CPTP with a D-dimer <500 ng/mL (prevalence = 0.1%; 95% CI, 0.0-0.8), low CPTP with a D-dimer between 500 ng/ml and 1000 ng/ml (prevalence = 0.3%; 95% CI, 0.0-1.7), and D-dimer <500 ng/ml in patients with high CPTP (prevalence = 0.3%; 95% CI, 0.0-1.0). Conclusions: The combination of D-dimer and Wells items resulted in a simple clinical decision rule with 3 items. The results suggest that the rule can safely exclude DVT. Prospective validation is required.
(Less)
- author
- Xu, Keying ; de Wit, Kerstin ; Geersing, Geert Jan ; Takada, Toshihiko ; Schutgens, Roger ; Elf, Johan LU ; Kearon, Clive and Parpia, Sameer
- organization
- publishing date
- 2021-07-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- deep vein thrombosis, diagnosis, fibrinogen, ultrasonography, venous thromboembolism
- in
- Journal of Thrombosis and Haemostasis
- volume
- 19
- issue
- 7
- pages
- 7 pages
- publisher
- Elsevier
- external identifiers
-
- pmid:33834620
- scopus:85105089654
- ISSN
- 1538-7933
- DOI
- 10.1111/jth.15337
- language
- English
- LU publication?
- yes
- id
- 0bd2c878-76ef-4305-9521-b01cc33816ab
- date added to LUP
- 2021-05-31 14:58:35
- date last changed
- 2025-01-13 08:46:02
@article{0bd2c878-76ef-4305-9521-b01cc33816ab,
abstract = {{<p>Background: Current clinical decision rules to exclude deep vein thrombosis (DVT) are underused partly because of their complexity. A simplified rule that can be easily applied would be more appealing to use in clinical practice. Methods: We used individual patient data from prospective diagnostic studies of patients suspected of DVT to develop a new clinical decision rule. The primary outcome was presence of DVT either at initial testing or during follow-up. DVT was considered safely excluded if the upper 95% confidence interval (CI) of DVT prevalence was <2%. Results: Four studies and 3368 patients were eligible for this analysis. Overall prevalence of DVT was 17%. In addition to D-dimer, two variables, calf swelling and DVT as the most likely diagnosis, are included in the new rule. Based on these two variables, two clinical pretest probability (CPTP) groups were defined; low (none of the two items present) and high (at least one of the items present). DVT can be safely excluded in patients with low CPTP with a D-dimer <500 ng/mL (prevalence = 0.1%; 95% CI, 0.0-0.8), low CPTP with a D-dimer between 500 ng/ml and 1000 ng/ml (prevalence = 0.3%; 95% CI, 0.0-1.7), and D-dimer <500 ng/ml in patients with high CPTP (prevalence = 0.3%; 95% CI, 0.0-1.0). Conclusions: The combination of D-dimer and Wells items resulted in a simple clinical decision rule with 3 items. The results suggest that the rule can safely exclude DVT. Prospective validation is required.</p>}},
author = {{Xu, Keying and de Wit, Kerstin and Geersing, Geert Jan and Takada, Toshihiko and Schutgens, Roger and Elf, Johan and Kearon, Clive and Parpia, Sameer}},
issn = {{1538-7933}},
keywords = {{deep vein thrombosis; diagnosis; fibrinogen; ultrasonography; venous thromboembolism}},
language = {{eng}},
month = {{07}},
number = {{7}},
pages = {{1752--1758}},
publisher = {{Elsevier}},
series = {{Journal of Thrombosis and Haemostasis}},
title = {{A simplified decision rule to rule out deep vein thrombosis using clinical assessment and D-dimer}},
url = {{http://dx.doi.org/10.1111/jth.15337}},
doi = {{10.1111/jth.15337}},
volume = {{19}},
year = {{2021}},
}