Outpatient duplex scanning for deep vein thrombosis: Parameters predictive of a negative study result

Nypaver, Timothy J.; Shepard, Alexander D.; Kiell, Charles S.; McPharlin, Michalene; Fenn, Nancy M.; Ernst, Calvin B.

doi:10.1016/0741-5214(93)90337-l

Cited by 36 publications

(15 citation statements)

References 21 publications

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“…Risk factors for VTE among the studied patients were inconsistently reported. The Wells prediction rule was most frequently evaluated in these studies (Table 1); only 2 studies validated other prediction rules, 27,28 and 1 study compared the Wells rule with other prediction rules. 24 In the 15 studies that evaluated the Wells DVT prediction rule, patients whose test scores put them in the highest strata of pretest probability had a prevalence of DVT, across studies, ranging from 17% to 85%.…”

Section: Are Clinical Prediction Rules Valuable For Diagnosing Dvt Ormentioning

confidence: 99%

“…The sensitivities and specifi cities of the rule (at each cutoff) refl ect how correctly the rule predicts the presence or absence of disease. We identifi ed 19 studies that evaluated clinical prediction rules for the diagnosis of DVT, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] and 8 studies evaluating clinical prediction rules for the diagnosis of pulmonary embolism, [35][36][37][38][39][40][41][42] although common patients were reported in 3 studies. [40][41][42] (Supplemental Appendix 1, available online at http://www.annfammed.org/cgi/content/full/5/1/63/DC1).…”

Section: Are Clinical Prediction Rules Valuable For Diagnosing Dvt Ormentioning

confidence: 99%

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Review of the Evidence on Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism

Segal

Eng

Tamariz

et al. 2007

The Annals of Family Medicine

139

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PURPOSE This review summarizes the evidence regarding the effi cacy of techniques for diagnosis of deep venous thrombosis (DVT) and pulmonary embolism. METHODSWe searched for studies using MEDLINE, MICROMEDEX, the Cochrane Controlled Trials Register, and the Cochrane Database of Systematic Reviews through June 2006. We reviewed randomized controlled trials, systematic reviews of trials, and observational studies if no trials were available. Paired reviewers assessed the quality of each included article and abstracted the data into summary tables. Heterogeneity in study designs precluded mathematical combination of the results of the primary literature. RESULTSOur review found 22 relevant systematic reviews and 36 primary studies. The evidence strongly supports the use of clinical prediction rules, particularly the Wells model, for establishing the pretest probability of DVT or pulmonary embolism in a patient before ordering more defi nitive testing. Fifteen studies support that when a D-dimer assay is negative and a clinical prediction rule suggests a low probability of DVT or pulmonary embolism, the negative predictive value is high enough to justify foregoing imaging studies in many patients. The evidence in 5 systematic reviews regarding the use of D-dimer, in isolation, is strong and demonstrates sensitivities of the enzyme-linked immunosorbent assay (ELISA) and quantitative rapid ELISA, pooled across studies, of approximately 95%. Eight systematic reviews found that the sensitivity and specifi city of ultrasonography for diagnosis of DVT vary by vein; ultrasonography performs best for diagnosis of symptomatic, proximal vein thrombosis, with pooled sensitivities of 89% to 96%. The sensitivity of single-detector helical computed tomography for diagnosis of pulmonary embolism varied widely across studies and was below 90% in 4 of 9 studies; more studies are needed to determine the sensitivity of multidetector scanners.CONCLUSIONS While the strength of the evidence varies across questions, it is generally strong.

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Section: Are Clinical Prediction Rules Valuable For Diagnosing Dvt Ormentioning

confidence: 99%

Section: Are Clinical Prediction Rules Valuable For Diagnosing Dvt Ormentioning

confidence: 99%

Review of the Evidence on Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism

Segal

Eng

Tamariz

et al. 2007

The Annals of Family Medicine

139

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“…Thus, a total of 43 proposals of recommendation were drawn up. Ten of these recommendations were deleted because no final agreement Surgery,12). To assist the panel, the recommendation data extraction form and related references were provided by e-mail.…”

Section: ) Guideline Developmentmentioning

confidence: 99%

“…The signs and symptoms of DVT are non-specific and may be associated with other lower extremity disorders, including lymphedema, PTS, superficial venous thrombosis, cellulitis, musculoskeletal trauma, and Baker's cysts. Among patients referred to the vascular laboratory for exclusion of DVT, only 12%-31% will have a positive ultrasound (US) study [10][11][12].The most common presenting symptoms have a wide range of reported sensitivities and specificities: calf pain, sensitivity 75%-91% and specificity 3%-87%; and calf swelling, sensitivity 35%-97% and specificity 8%-88% [13][14][15][16][17][18]. None of the signs or symptoms is sufficiently sensitive or specific, either alone or in combination, to accurately diagnose or exclude thrombosis [19].…”

Section: ) Symptomsmentioning

confidence: 99%

Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

Kim

Min

Kang

et al. 2016

J Korean Soc Radiol

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“…Hence, there are wide confidence limits on the results. Nypaver et al [20] also derived a clinical prediction score, the main limitations in this case being the small number of patients enrolled and the fact that ultrasound and clinical assessments were unblinded. If patients had no history of cancer, had less than a 3-cm difference in thigh circumference, and had had symptoms for more than 7 days, the probability of DVT was 3.3%.…”

Section: Principle Of Clinical Assessmentmentioning

confidence: 99%

Modern Approach to Diagnosis in Patients with Suspected Deep Vein Thrombosis

Wells

Anderson

1999

Pathophysiol Haemos Thromb

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Deep vein thrombosis is a relatively common disease, amenable to therapy but with a potentially fatal outcome if untreated. The diagnosis can be made in most patients with the non-invasive imaging procedure ultrasonography, but limitations exist. As with all tests, there is a potential for false-positive and false-negative results. The latter are especially an issue for calf vein thrombi, and this in part has led to the concept of serial testing of the proximal venous system rather than imaging the calf. The premise of the repeat (serial) test is that only thrombi that extend to the proximal system are clinically relevant and such thrombi will be detected on the repeat test. However, despite the safety of the serial-testing concept, it is inconvenient and expensive. In the last few years, the diagnostic process has been improved by the validation of a clinical model that accurately categorizes patients as having low, moderate or high probability of deep vein thrombosis. Among the improvements this provides is the elimination of serial testing if the ultrasound is normal and the clinical probability low. The fibrin degradation product D-dimer has been demonstrated to have a high negative predictive value and has also proven useful in diagnostic algorithms. The combination of the D-dimer with clinical model assessment will enable diagnostic-testing strategies that are more safe, effective and convenient for patients.

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Outpatient duplex scanning for deep vein thrombosis: Parameters predictive of a negative study result

Cited by 36 publications

References 21 publications

Review of the Evidence on Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism

Review of the Evidence on Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism

Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

Modern Approach to Diagnosis in Patients with Suspected Deep Vein Thrombosis

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