Comparing the diagnostic performance of 2 clinical decision rules to rule out deep vein thrombosis in primary care patients
PURPOSE: The Wells rule is widely used for clinical assessment of patients with suspected deep vein thrombosis (DVT), especially in the secondary care setting. Recently a new clinical decision rule for primary care patients (the primary care rule) has been proposed, because the Wells rule is not sufficient to rule out DVT in this setting. The objective was to compare the ability of both rules to safely rule out DVT and to efficiently reduce the number of referrals for leg ultrasound investigation that would result in a negative finding.
METHODS: Family physicians collected data on 1,086 patients to calculate the scores for both decision rules before leg ultrasonography was performed. In all patients D-dimer (dimerized plasmin fragment D) testing was performed using a rapid point-of-care assay. Patients were stratified into risk categories defined by each rule and the D-dimer result. Outcomes were DVT (diagnosed by ultrasonography) and venous thromboembolic complications or death caused by a possible thromboembolic event during a 90-day follow-up period. We calculated the differences between the 2 rules in the number of missed diagnoses and the proportions of patients that needed ultrasound testing.
RESULTS: Data from 1,002 eligible patients were used for this analysis. A venous thromboembolic event occurred during follow-up in 7 patients with a low score and negative D-dimer finding, both with the Wells rule (7 of 447; 1.6%; 95% confidence interval [CI], 0.7%-3.3% ) and the primary care rule (7 of 495; 1.4%; 95% CI, 0.6%-3.0%). Using the Wells rule, 447 patients (45%) would not need referral for further testing compared with 495 patients (49%) when using the primary care rule (McNemar P <.001).
CONCLUSIONS: In primary care, suspected DVT can safely be ruled out using either of the 2 rules in combination with a point-of-care D-dimer test. Both rules can reduce unnecessary referrals for compression ultrasonography by about 50%, though the primary care rule reduces it slightly more.
| Errataetall: |
CommentIn: Praxis (Bern 1994). 2011 May 11;100(10):619-20. - PMID 21563102 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2011 |
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| Erschienen: |
2011 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:9 |
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| Enthalten in: |
Annals of family medicine - 9(2011), 1 vom: 15. Jan., Seite 31-6 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
van der Velde, Eit Frits [VerfasserIn] |
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| Links: |
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| Themen: |
Comparative Study |
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| Anmerkungen: |
Date Completed 25.04.2011 Date Revised 20.10.2021 published: Print CommentIn: Praxis (Bern 1994). 2011 May 11;100(10):619-20. - PMID 21563102 Citation Status MEDLINE |
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| doi: |
10.1370/afm.1198 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM205130003 |
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| 100 | 1 | |a van der Velde, Eit Frits |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Comparing the diagnostic performance of 2 clinical decision rules to rule out deep vein thrombosis in primary care patients |
| 264 | 1 | |c 2011 | |
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| 500 | |a Date Completed 25.04.2011 | ||
| 500 | |a Date Revised 20.10.2021 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: Praxis (Bern 1994). 2011 May 11;100(10):619-20. - PMID 21563102 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a PURPOSE: The Wells rule is widely used for clinical assessment of patients with suspected deep vein thrombosis (DVT), especially in the secondary care setting. Recently a new clinical decision rule for primary care patients (the primary care rule) has been proposed, because the Wells rule is not sufficient to rule out DVT in this setting. The objective was to compare the ability of both rules to safely rule out DVT and to efficiently reduce the number of referrals for leg ultrasound investigation that would result in a negative finding | ||
| 520 | |a METHODS: Family physicians collected data on 1,086 patients to calculate the scores for both decision rules before leg ultrasonography was performed. In all patients D-dimer (dimerized plasmin fragment D) testing was performed using a rapid point-of-care assay. Patients were stratified into risk categories defined by each rule and the D-dimer result. Outcomes were DVT (diagnosed by ultrasonography) and venous thromboembolic complications or death caused by a possible thromboembolic event during a 90-day follow-up period. We calculated the differences between the 2 rules in the number of missed diagnoses and the proportions of patients that needed ultrasound testing | ||
| 520 | |a RESULTS: Data from 1,002 eligible patients were used for this analysis. A venous thromboembolic event occurred during follow-up in 7 patients with a low score and negative D-dimer finding, both with the Wells rule (7 of 447; 1.6%; 95% confidence interval [CI], 0.7%-3.3% ) and the primary care rule (7 of 495; 1.4%; 95% CI, 0.6%-3.0%). Using the Wells rule, 447 patients (45%) would not need referral for further testing compared with 495 patients (49%) when using the primary care rule (McNemar P <.001) | ||
| 520 | |a CONCLUSIONS: In primary care, suspected DVT can safely be ruled out using either of the 2 rules in combination with a point-of-care D-dimer test. Both rules can reduce unnecessary referrals for compression ultrasonography by about 50%, though the primary care rule reduces it slightly more | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
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| 650 | 7 | |a fibrin fragment D |2 NLM | |
| 700 | 1 | |a Toll, Diane B |e verfasserin |4 aut | |
| 700 | 1 | |a Ten Cate-Hoek, Arina J |e verfasserin |4 aut | |
| 700 | 1 | |a Oudega, Ruud |e verfasserin |4 aut | |
| 700 | 1 | |a Stoffers, Henri E J H |e verfasserin |4 aut | |
| 700 | 1 | |a Bossuyt, Patrick M |e verfasserin |4 aut | |
| 700 | 1 | |a Büller, Harry R |e verfasserin |4 aut | |
| 700 | 1 | |a Prins, Martin H |e verfasserin |4 aut | |
| 700 | 1 | |a Hoes, Arno W |e verfasserin |4 aut | |
| 700 | 1 | |a Moons, Karel G M |e verfasserin |4 aut | |
| 700 | 1 | |a van Weert, Henk C P M |e verfasserin |4 aut | |
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