Deep vein thrombosis assessment of clinical probability and risk scores: Difference between revisions
Rim Halaby (talk | contribs) |
Rim Halaby (talk | contribs) |
||
Line 57: | Line 57: | ||
A modified scoring system stratifies the patients as likely (≥ 2, 28% prevalence) or unlikely (< 2, 6% prevalence) based on the score of 2. | A modified scoring system stratifies the patients as likely (≥ 2, 28% prevalence) or unlikely (< 2, 6% prevalence) based on the score of 2. | ||
===Limitations of Wells score=== | ====Limitations of Wells score==== | ||
* The accuracy of the Wells rule, though useful in secondary and tertiary care centers, has not been properly validated for use in primary care patients with the suspicion of DVT.<ref name="pmid16027451">{{cite journal |author=Oudega R, Hoes AW, Moons KG |title=The Wells rule does not adequately rule out deep venous thrombosis in primary care patients |journal=Ann. Intern. Med. |volume=143 |issue=2 |pages=100–7 |year=2005 |month=July |pmid=16027451|doi=|url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=16027451 |accessdate=2011-12-22}}</ref> | * The accuracy of the Wells rule, though useful in secondary and tertiary care centers, has not been properly validated for use in primary care patients with the suspicion of DVT.<ref name="pmid16027451">{{cite journal |author=Oudega R, Hoes AW, Moons KG |title=The Wells rule does not adequately rule out deep venous thrombosis in primary care patients |journal=Ann. Intern. Med. |volume=143 |issue=2 |pages=100–7 |year=2005 |month=July |pmid=16027451|doi=|url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=16027451 |accessdate=2011-12-22}}</ref> | ||
* The performance of the Wells score was decreased when evaluating elderly patients, patients with a prior DVT, or patients having other comorbidities. These results may be equivalent to what is found in a primary care setting.<ref name="pmid16027455">{{cite journal |author=Goodacre S, Sutton AJ, Sampson FC|title=Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis |journal=Ann. Intern. Med. |volume=143|issue=2|pages=129–39 |year=2005 |month=July |pmid=16027455 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=16027455|accessdate=2011-12-22}}</ref><ref name="pmid17261865">{{cite journal |author=Qaseem A, Snow V, Barry P, Hornbake ER, Rodnick JE, Tobolic T, Ireland B, Segal J, Bass E, Weiss KB, Green L, Owens DK |title=Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians |journal=Ann Fam Med |volume=5 |issue=1 |pages=57–62 |year=2007 |pmid=17261865|pmc=1783928 |doi=10.1370/afm.667|url=http://www.annfammed.org/cgi/pmidlookup?view=long&pmid=17261865 |accessdate=2011-12-22}}</ref> Also, it should be highlighted that Wells criteria is an additional tool to diagnosis rather than being a stand-alone test. | * The performance of the Wells score was decreased when evaluating elderly patients, patients with a prior DVT, or patients having other comorbidities. These results may be equivalent to what is found in a primary care setting.<ref name="pmid16027455">{{cite journal |author=Goodacre S, Sutton AJ, Sampson FC|title=Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis |journal=Ann. Intern. Med. |volume=143|issue=2|pages=129–39 |year=2005 |month=July |pmid=16027455 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=16027455|accessdate=2011-12-22}}</ref><ref name="pmid17261865">{{cite journal |author=Qaseem A, Snow V, Barry P, Hornbake ER, Rodnick JE, Tobolic T, Ireland B, Segal J, Bass E, Weiss KB, Green L, Owens DK |title=Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians |journal=Ann Fam Med |volume=5 |issue=1 |pages=57–62 |year=2007 |pmid=17261865|pmc=1783928 |doi=10.1370/afm.667|url=http://www.annfammed.org/cgi/pmidlookup?view=long&pmid=17261865 |accessdate=2011-12-22}}</ref> Also, it should be highlighted that Wells criteria is an additional tool to diagnosis rather than being a stand-alone test. | ||
===AMUSE Score=== | |||
The AMUSE score includes clinical variables in addition to the results of [[D-dimer]] test to evaluate the need to proceed with [[ultrasonography]] among patients with suspected [[DVT]]. | |||
====Calculation of the AMUSE Score==== | |||
====Interpretation of the AMUSE Score==== | |||
====Limitations of the AMUSE Score==== | |||
==References== | ==References== |
Revision as of 21:27, 29 May 2014
Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] ; Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet
Deep Vein Thrombosis Microchapters |
Diagnosis |
---|
Treatment |
Special Scenario |
Trials |
Case Studies |
Deep vein thrombosis assessment of clinical probability and risk scores On the Web |
FDA on Deep vein thrombosis assessment of clinical probability and risk scores |
CDC on Deep vein thrombosis assessment of clinical probability and risk scores |
Deep vein thrombosis assessment of clinical probability and risk scores in the news |
Blogs on Deep vein thrombosis assessment of clinical probability and risk scores |
Overview
In a patient with suspected deep vein thrombosis (DVT), establishing a pre-test probability helps in early risk stratification and appropriate use of laboratory tests and imaging modalities. Many pretest probability scoring systems are proposed for use in primary care patients, such as Wells score, Hamilton score, and AMUSE score; however, the most studied of them is Wells score.[1][2] When combined with pretest probability, ultrasonography and D-dimer tests are most useful in the diagnosis of DVT.
Pretest Probability
Wells Score
Calculation of Wells Score for DVT
The Wells score is the most widely used tool to assess pre-test probability. It includes 10 clinical questions, with the score ranging from -2 to 9. Pretest probability guides the interpretation of test results. It includes risk factors and examination findings.
Wells score calculator for DVT
Variables | Score[3] |
Active cancer with either palliative therapy or treatment that is either ongoing or within the prior 6 months | 1 |
Patient was recently bedridden for at least 3 days OR Major surgery in the prior 12 weeks necessitating general or regional anesthesia |
1 |
Recent plaster immobilization, paresis or paralysis of the lower extremities | 1 |
Tenderness that is localized is the distribution of the deep veins | 1 |
Leg is entirely swollen | 1 |
Calf is swollen for 3 cm or move compared to the other calf | 1 |
Pitting edema in the symptomatic leg | 1 |
Presence of collateral superficial veins | 1 |
Previous DVT | 1 |
There is an alternative diagnosis as likely as DVT | -2 |
Interpretation of Wells Score for DVT
Score | Pretest probability[3][4] |
≥3 | High
(Prevalence of DVT - 53%) |
1 or 2 | Moderate
(Prevalence of DVT - 17%) |
0 or less | Low
(Prevalence of DVT - 5%) |
A modified scoring system stratifies the patients as likely (≥ 2, 28% prevalence) or unlikely (< 2, 6% prevalence) based on the score of 2.
Limitations of Wells score
- The accuracy of the Wells rule, though useful in secondary and tertiary care centers, has not been properly validated for use in primary care patients with the suspicion of DVT.[5]
- The performance of the Wells score was decreased when evaluating elderly patients, patients with a prior DVT, or patients having other comorbidities. These results may be equivalent to what is found in a primary care setting.[6][7] Also, it should be highlighted that Wells criteria is an additional tool to diagnosis rather than being a stand-alone test.
AMUSE Score
The AMUSE score includes clinical variables in addition to the results of D-dimer test to evaluate the need to proceed with ultrasonography among patients with suspected DVT.
Calculation of the AMUSE Score
Interpretation of the AMUSE Score
Limitations of the AMUSE Score
References
- ↑ Subramaniam RM, Chou T, Heath R, Allen R (2006). "Importance of pretest probability score and D-dimer assay before sonography for lower limb deep venous thrombosis". AJR Am J Roentgenol. 186 (1): 206–12. doi:10.2214/AJR.04.1398. PMID 16357403. Retrieved 2011-12-22. Unknown parameter
|month=
ignored (help) - ↑ van der Velde EF, Toll DB, Ten Cate-Hoek AJ, Oudega R, Stoffers HE, Bossuyt PM, Büller HR, Prins MH, Hoes AW, Moons KG, van Weert HC (2011). "Comparing the diagnostic performance of 2 clinical decision rules to rule out deep vein thrombosis in primary care patients". Ann Fam Med. 9 (1): 31–6. doi:10.1370/afm.1198. PMC 3022042. PMID 21242558. Retrieved 2011-12-22.
- ↑ 3.0 3.1 Wells PS, Owen C, Doucette S, Fergusson D, Tran H (2006). "Does this patient have deep vein thrombosis?". JAMA. 295 (2): 199–207. doi:10.1001/jama.295.2.199. PMID 16403932. Review in: Evid Based Med. 2006 Aug;11(4):119 Review in: ACP J Club. 2006 Jul-Aug;145(1):24
- ↑ Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L; et al. (1997). "Value of assessment of pretest probability of deep-vein thrombosis in clinical management". Lancet. 350 (9094): 1795–8. doi:10.1016/S0140-6736(97)08140-3. PMID 9428249.
- ↑ Oudega R, Hoes AW, Moons KG (2005). "The Wells rule does not adequately rule out deep venous thrombosis in primary care patients". Ann. Intern. Med. 143 (2): 100–7. PMID 16027451. Retrieved 2011-12-22. Unknown parameter
|month=
ignored (help) - ↑ Goodacre S, Sutton AJ, Sampson FC (2005). "Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis". Ann. Intern. Med. 143 (2): 129–39. PMID 16027455. Retrieved 2011-12-22. Unknown parameter
|month=
ignored (help) - ↑ Qaseem A, Snow V, Barry P, Hornbake ER, Rodnick JE, Tobolic T, Ireland B, Segal J, Bass E, Weiss KB, Green L, Owens DK (2007). "Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians". Ann Fam Med. 5 (1): 57–62. doi:10.1370/afm.667. PMC 1783928. PMID 17261865. Retrieved 2011-12-22.