Comparison of 3 Postthrombotic Syndrome Assessment Scales Demonstrates Significant Variability in Children and Adolescents With Deep Vein Thrombosis

Abstract

Postthrombotic syndrome (PTS) is an important outcome in children with deep vein thrombosis (DVT). There are several instruments to measure PTS, and no accepted "gold standard." The objective of this cross-sectional prospective study was to compare the prevalence of PTS in patients above 8 years old with a history of DVT using 3 scales: the Villalta scale, a pediatric modification of the Villalta scale, and the Manco-Johnson instrument. Forty-four subjects (22 females) were enrolled; mean age 16.6 years (SD 3.6 y). The majority had a lower extremity DVT. The average duration from DVT to PTS assessment was 2.6 years. The proportion of subjects with PTS using the adult Villalta scale was 11%, which was significantly less than the 66% of patients identified using both pediatric scales (P<0.0001). The majority of patients with PTS as determined by the pediatric scales had mild PTS. There was significant discordance between the prevalence of PTS using the Villalta scale compared with the 2 pediatric scales. This is especially relevant when considering which instrument to use in adolescent patients. This study demonstrates that PTS, as defined by these scales, is not a well-defined or standardized outcome, particularly when comparing adult and pediatric instruments.

Inferior vena cava atresia predisposing to acute lower extremity deep vein thrombosis in children: A descriptive dual‐center study

“…Also, we do not have PTS scoring on all 18 patients, nor do all 18 patients have scoring with both the Villalta and modified Villalta. These two scores have shown significant variability in young pediatric and adolescent patients, with higher rates of positive PTS scoring using the modified Villalta scale compared with the Villalta scale.…”

Post thrombotic syndrome following deep vein thrombosis in paediatric patients

“…There is good correlation between the modified Villalta Scale and the Manco-Johnson instrument in assessing paediatric PTS and the use of both is advocated. 47,55 However, when these were compared with the adult Villalta Scale in children aged 12–18, significant discrepancy was identified with 66% of children diagnosed as having PTS using the modified Villalta Scale, but only 11% when using the adult version. 55 This raises questions over when adult scales become appropriate in paediatric practice.…”

Predictors of postthrombotic syndrome in pediatric thrombosis: A systematic review and meta‐analysis of the literature

“…Although the use of these tools is a step in the right direction toward a standardized definition of PTS, a shared limitation of these instruments is their inability to fully measure the functional impact of PTS in children, limiting their sensitivity to distinguish clinically significant (cs) from non‐cs PTS, and likely leading to the overdiagnosis of this complication in children 10 . Although both tools have shown a very good correlation with each other when identifying PTS as present or absent, this correlation decreases when characterizing PTS by severity, highlighting the disparity in their definition and sensitivity to detect PTS in its more severe forms 11 . Thus, the full clinical impact of pediatric PTS and the true incidence of cs‐PTS remain to be elucidated.…”