Performance of Wells Score for Deep Vein Thrombosis in the Inpatient Setting

Balthazar, Patricia; Ip, Ivan K.; Goldhaber, S.Z.

doi:10.1016/j.jvs.2015.12.013

Cited by 24 publications

(41 citation statements)

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“…While a recent prospective study of the use of the Wells score among inpatients (who comprised about half the patients in the present study) suggests poor discrimination compared to its use in outpatients, other studies suggest reasonably good discrimination in both inpatient and outpatient settings . Nevertheless, the AUC of 0.67 in this study is consistent with a significant degree of misclassification, and hence, the score by itself, in the absence of D‐dimer testing and consideration of risk factors not contained in the Wells score, should not be relied on as the sole arbiter of decisions to request or not request CTPA in patients with suspected PTE.…”

Section: Discussioncontrasting

confidence: 82%

Underuse of risk assessment and overuse of computed tomography pulmonary angiography in patients with suspected pulmonary thromboembolism

Perera

Aggarwal

Scott

et al. 2017

Internal Medicine Journal

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Section: Discussioncontrasting

confidence: 82%

Underuse of risk assessment and overuse of computed tomography pulmonary angiography in patients with suspected pulmonary thromboembolism

Perera

Aggarwal

Scott

et al. 2017

Internal Medicine Journal

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“…We developed the Himi score for risk assessment for the onset of DVT by using factors that multivariate analysis showed to be significantly related to DVT, and compared the accuracy of this score with those of the Wells and Padua scores. Consistent with the score ranges reported in previous studies (Wells: 0.9–2.38; Padua: 2–4.56), the average Wells and Padua scores were 1.39 and 3.21, respectively . However, the AUC of the Himi score was significantly higher than those of Wells and Padua scores.…”

Section: Discussionsupporting

confidence: 89%

New score including daily life independence levels with dementia is associated with the onset of deep vein thrombosis in frail older adults

Nakanishi

Kanda

Kobata

et al. 2020

Geriatrics Gerontology Int

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Aim: The detailed risk factors of deep vein thrombosis (DVT) remain unknown, and no efficient tool to assess the risk of the development of DVT among older adults has been established. This study aimed to clarify the risk factors, including the level of daily life independence, and develop an assessment score for DVT in older patients. Methods:We recruited 252 patients aged ≧65 years with suspected deep vein thrombosis. Risk factors for deep vein thrombosis, cognitive impairment, laboratory data and level of daily life independence were analyzed to calculate the odds ratios for the onset of DVT with logistic regressions. The Himi score was generated with factors significantly related to DVT by adjusting the respective odds ratios. The discrimination accuracy of the Himi score associated with the onset of DVT was compared with those of conventional scores (Wells score, Padua score) based on the area under the receiver operating characteristic curve.Results: Low levels of daily life independence, D-dimer level >3.0 μg/mL, anticoagulant use, cancer and immobilization or symptoms of the lower limbs were associated with the onset of DVT. The discrimination accuracy of Himi scores composed of these related factors was significantly higher than those of the Wells and Padua scores.Conclusions: Achieving a better performance than did the Wells and Padua scores, the Himi score could be used to assess the risk of DVT in frail older adults. Geriatr Gerontol Int 2020; 20: 414-421.Logistic regression was used to validate risk markers in study patients, and to calculate the crude and adjusted OR for different risk markers for the onset of DVT. In addition, 95% confidence intervals (95% CI) were reported. In addition to age and sex, variables with a P-value of <0.05 in univariate logistic analysis were

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“…By modifying our institutional clinical decision support (CDS) system to enable the necessary granular clinical data collection, we were able to obviate the need for resource intensive retrospective chart reviews. To our knowledge, this is the second example of a CDS tool specifically designed for capture of discrete data to validate a decision rule . A similar process may also be useful to accelerate generation of new decision rules.…”

Section: Discussionmentioning

confidence: 99%

External validation of risk stratification strategy in the use of renal ultrasonography in the evaluation of acute kidney injury

Balthazar

Alper

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Per the American College of Radiology Appropriateness Criteria, renal ultrasound is the most appropriate imaging examination to evaluate patients with acute kidney injury. However, recent studies suggest that renal ultrasound may be more selectively performed, which could lead to reductions in the use of medical imaging. OBJECTIVE Evaluate a published risk stratification prediction model (the Licurse model) for using renal ultrasound in hospitalized patients with acute kidney injury. DESIGN Prospective, observational cohort study. SETTING A 793‐bed, quaternary care, academic hospital. PATIENTS All adult hospitalized patients who underwent renal ultrasound for the indication of acute kidney injury. INTERVENTION/EXPOSURE None. MEASUREMENTS Primary outcome was rate of hydronephrosis diagnosed on ultrasound. Secondary outcome was rate of hydronephrosis resulting in urologic intervention. RESULTS Of 778 patients who underwent renal ultrasonography to evaluate acute kidney injury, hydronephrosis was present in 106 (13.6%); urologic intervention was performed in 23 patients (3.0%). The Licurse model had sensitivity of 91.3% (95% confidence interval [CI]: 73.2%‐97.6%) for urologic intervention and 93.4% (95% CI: 87.2%‐96.8%) for hydronephrosis, respectively. Specificity was low for urologic intervention (23.0% [95% CI: 20.2‐26.2]) and hydronephrosis (25.1% [95% CI: 22.0‐28.6]). We estimated that for 22.6% of patients, hydronephrosis could be ruled out based on clinical predictors. CONCLUSIONS We found that the Licurse renal ultrasonography risk stratification model was sufficiently accurate in classifying patients at risk for ureteral obstruction among hospitalized patients with acute kidney injury. Journal of Hospital Medicine 2016;11:763–767. © 2016 Society of Hospital Medicine

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Performance of Wells Score for Deep Vein Thrombosis in the Inpatient Setting

Cited by 24 publications

References 0 publications

Underuse of risk assessment and overuse of computed tomography pulmonary angiography in patients with suspected pulmonary thromboembolism

Underuse of risk assessment and overuse of computed tomography pulmonary angiography in patients with suspected pulmonary thromboembolism

New score including daily life independence levels with dementia is associated with the onset of deep vein thrombosis in frail older adults

External validation of risk stratification strategy in the use of renal ultrasonography in the evaluation of acute kidney injury

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