Impact of venography on the diagnosis and management of deep vein thrombosis.

Ramsay, L. E.

doi:10.1136/bmj.286.6366.698

Cited by 36 publications

(12 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…With the advent of widespread availability of objective testing over 3 decades ago, it became apparent that VTE was confirmed in fewer than half of patients in whom it was suspected [23,24], a proportion that has subsequently fallen further as a result of improved access to diagnostic testing and a generally declining threshold for diagnostic uncertainty. Evidently, many patients presumed to have VTE on the basis of signs and symptoms in the pre‐imaging era were incorrectly diagnosed and inappropriately treated, and interest in the discriminatory value of the clinical assessment, other than to alert the clinician to the need for objective testing, was largely abandoned for the next 2 decades.…”

Section: Assessment Of Ptp In Patients With Suspected Vtementioning

confidence: 99%

The utility of pretest probability assessment in patients with clinically suspected venous thromboembolism

Kelly

Hunt

2003

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

Summary. The assessment of pretest probability (PTP), with stratification into low‐, intermediate‐ and high‐risk groups is an essential initial step in the current diagnostic management of patients with suspected venous thromboembolism (VTE). In combination with additional information, it reduces the need for initial and supplementary imaging, and allows considerable refinement of the posterior probability of VTE following non‐invasive imaging. PTP may be assessed either empirically or by using various decision rules or scoring systems, the best known of which are the simplified Wells scores for suspected deep vein thrombosis (DVT) and pulmonary embolism (PE), and the Geneva score for suspected PE. Each of these approaches shows similar directional and categorical accuracy, and has been validated as facilitating clinically useful classification of the PTP, although an overview of data suggests that fewer patients tend to be classified as low PTP when assessed empirically. This group is the most important to identify, as several outcome studies have shown that imaging and treatment are safely obviated in outpatients with suspected DVT or PE who have a low PTP in combination with negative d‐dimer testing, a subgroup accounting for up to half of all patients studied. Hence, while probably not of critical importance, the explicit approach offered by scoring systems might be preferred over empirical assessment, particularly when used by more junior staff.

show abstract

Section: Assessment Of Ptp In Patients With Suspected Vtementioning

confidence: 99%

The utility of pretest probability assessment in patients with clinically suspected venous thromboembolism

Kelly

Hunt

2003

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

show abstract

“…DEEP VENOUS THROMBOSIS (DVT) and pulmonary embolism are major causes of morbidity and mortality. It is estimated that as many as 5 million episodes of DVT occur in the United States annually (1-3) and 8595% of pulmonary emboli originate as DVT in the pelvis and lower extremities (4)(5)(6)(7)(8)(9). Accordingly, the detection of DVT is of major clinical importance.…”

mentioning

confidence: 99%

Detection of deep venous thrombosis: Prospective comparison of MR imaging and sonography

Evans

Sostman

Witty

et al. 1996

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Seventy-five patients (41 women and 34 men, 20-85 years old) with clinically suspected deep venous thrombosis (DVT) were examined with MR imaging and sonography. In 26 patients, the final diagnosis was acute femoropopliteal DVT. The sensitivity of MR imaging for detecting this disease was 100% with a 95% confidence interval (CI) of 87-100%; the specificity was 100% with a CI of 92-100%; and the accuracy was 96% with a CI of 89-99%. The correspond-ing sensitivity of sonography was 77% with a CI of 53-92%; the specificity was 98% with a CI of 89-100%; and the accuracy was 83% with a CI of 72-90%. In four of the 75 patients, MR images revealed thrombus of the pelvis (n = 1) or calf (n = 3) without femoropopliteal involvement. The estimated prevalence of isolated calf and/or pelvic DVT was 5% with a CI of 1-13%. MR imaging is significantly more sensitive (P = .02) and accurate (P < .01) than sonography in the detection of lower extremity DVT, but there was no difference in the specificity of MR imaging and that of sonography (P = .31).

show abstract

“…First, like all studies performed before the advent of widespread use of venography and pulmonary angiography, VTE was diagnosed clinically. Subsequent studies using objective diagnostic methods found that VTE was confirmed in less than half of patients in whom it had been suspected [21, 37, 38], so that early series contain a proportion of patients with diagnoses other that VTE. It should be noted, however, that alternative diagnoses in patients presenting with symptoms suggestive of DVT are rarely life threatening, whilst those in patients presenting with symptoms suggesting PE, such as pneumonia and myocardial infarction, may well be.…”

Section: Rcts Of Anticoagulants In Symptomatic Vtementioning

confidence: 99%

Do anticoagulants improve survival in patients presenting with venous thromboembolism?

Kelly

Hunt

2003

Journal of Internal Medicine

View full text Add to dashboard Cite

show abstract

Impact of venography on the diagnosis and management of deep vein thrombosis.

Cited by 36 publications

References 11 publications

The utility of pretest probability assessment in patients with clinically suspected venous thromboembolism

The utility of pretest probability assessment in patients with clinically suspected venous thromboembolism

Detection of deep venous thrombosis: Prospective comparison of MR imaging and sonography

Do anticoagulants improve survival in patients presenting with venous thromboembolism?

Contact Info

Product

Resources

About