Value of assessment of pretest probability of deep-vein thrombosis in clinical management

Wells, Philip S.; Anderson, David R.; Bormanis, Janis; Guy, Fred; Mitchell, Michael J.; Gray, Lisa; Clement, Cathy; Robinson, Katherine; Lewandowski, Bernard

doi:10.1016/s0140-6736(97)08140-3

Cited by 1,092 publications

(848 citation statements)

References 15 publications

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“…• Surgery longer than 30 minutes; Wells et al (1995), the modified method of Wells et al (1997) and the Brazilian Society of Angiology and Vascular Surgery (SBACV) protocol cited by Maffei et al (2005) was evaluated using double entry tables and the concordance Kappa coefficient, in addition to the observed accuracy. The classification of concordance was made according to the suggestion by Altman (1991) and according to the Kappa value: < 0.20 (very low), 0.21-0.40 (low), 0.41-0.60 (moderate), 0.61-0.80 (good) and 0.81-1.00 (very good), as cited by Perroca and Gaidzinski (2003 Wells et al (1995Wells et al ( , 1997, the protocol for prophylaxis of deep venous thrombosis from the SBACV cited by Maffei et al (2005) and the predictive method of this study.…”

Section: Sample Selectionmentioning

confidence: 99%

“…The classification of concordance was made according to the suggestion by Altman (1991) and according to the Kappa value: < 0.20 (very low), 0.21-0.40 (low), 0.41-0.60 (moderate), 0.61-0.80 (good) and 0.81-1.00 (very good), as cited by Perroca and Gaidzinski (2003 Wells et al (1995Wells et al ( , 1997, the protocol for prophylaxis of deep venous thrombosis from the SBACV cited by Maffei et al (2005) and the predictive method of this study. Table 1 below shows each risk factor related to the thrombotic event probability used in the predictive method as well as the references from the literature used.…”

Section: Sample Selectionmentioning

confidence: 99%

“…Among the methods in the literature chosen for comparison with the method in this study were the clinical methods by Wells et al (1995) and the modified method of Wells et al (1997) because these methods had the most appropriate methodology and an efficient categorization of patients. According to Kahn (1998), these methods were more effective than the method for the Protocol for the Prevention of Thrombosis from the Brazilian Society of Angiology and Vascular Surgery (BSAVS) cited by Maffei et al (2005).…”

Section: Introductionmentioning

confidence: 99%

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A novel method for predicting the risk of thrombosis and thromboembolism

Leite

Marques

2014

Rev. Bras. Eng. Bioméd.

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Introduction: Thrombosis is a complex disease that is often silent and is characterized by thrombus formation within the blood vessel. It can lead to a venous obstruction in the body, severe sequelae and even death. Thrombus formation occurs when there is reduced blood flow and/or the release of procoagulant substances caused by external factors. In Brazil, the data on this pathology are still underestimated, and its incidence is approximately 0.8 cases/1000 inhabitants per year according to the literature. The aim of this study was to develop and validate a predictive method for the risk of thrombosis or thromboembolism according to various risk factors. Methods: This is an observational and retrospective study based on a convenience sample of records. It was approved by the Institutional Review Board (IRB) of the University Mogi das Cruzes and the Heart Hospital of the São Paulo. The sample was classified according to the risk, and the assessment of concordance was performed by determining the Kappa coefficient and accuracy. Results: Of the observed patients, 23 (46%) were women, and 86% were over 45 years old. The mean age of the patients was 60.8 years. Forty-eight percent of the patients underwent surgery for more than 30 minutes. In this study, the method categorized 29 (58%) patients as moderate risk, 10 as low risk and 11 as high risk. Two cases of thrombotic disease were sufficient for validation. Conclusion: The use of this software as a predictive method was feasible, providing fast filling, immediate scoring, flexibility and an upgrade over previous systems. The software will not substitute for diagnosis, which is a medical competence, but it may help as a warning of risk.

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Section: Sample Selectionmentioning

confidence: 99%

Section: Sample Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A novel method for predicting the risk of thrombosis and thromboembolism

Leite

Marques

2014

Rev. Bras. Eng. Bioméd.

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“…[2][3][4]. Comparison between data waiting and mortality showed an increase of mortality in some way associated to the diagnostic data timing of supply, with an Data related to mortality and morbidity of TE linked to the specialty of the clinical departments where patients are treated were taken into consideration.…”

Section: Medical Treatment Before and After Surgerymentioning

confidence: 99%

“…Therefore, predictive algorithms that should help to identify high-risk subjects (i.e., those who require intensive prophylaxis) have been defined. 2,4 Appropriate use of the guidelines is thus an opportunity to decrease mortality and morbidity rates in this setting. 2,5,6 We have considered that, in addition to appropriate knowledge of the issue, the availability of specific technical resources in each health-care structure may affect dramatically the way guidelines are applied.…”

Section: Introductionmentioning

confidence: 99%

Guidelines for Venous Thromboembolism and Clinical Practice in Italy: A Nationwide Survey

Franciscis¹,

Agus²,

Bisacci³

et al. 2008

Annals of Vascular Surgery

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Venous thromboembolism (VTE) is a common health problem for today's society, and considering the role that it plays in surgical patients (general surgery, gynecology, and orthopedics), new advances in our understanding of the procedures and trauma characteristics are relevant and necessary. The most important and recently published guidelines concerning this problem have been taken into consideration, leading to articulate investigations and data evaluation. This project has proposed a data-survey framework available as a questionnaire in order to investigate application of the guidelines for VTE throughout the national territory. Of the total 714 Italian centers, a random sample of 214 were contacted and asked to take part in this study; of these, 146 replied (20.4% of total and 68.2% of the sample): 48 departments of general surgery, 46 departments of gynecology, and 52 departments of orthopedics. About 70% of the centers has appropriate information about surgery as a risk factor for VTE. The answers have provided evidence of an adequate knowledge of the instrumental and laboratory diagnostic pathways, useful to confirm the diagnosis of TE (80%). Data waiting compared with morbidity and mortality rates related to deep vein thrombosis and pulmonary embolism showed an increase of mortality associated with the diagnostic data timing of supply, with an exponential trend linked to the data acquisition delay. Both risk stratification and adequate application of prophylaxis together with treatment devices represent a real tool to control morbidity and mortality for VTE. Moreover, diagnostic data waiting significantly influences adequate prophylaxis. In Italy, only 40% of the centers are ready to provide diagnostic data within 12 hr.

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The Clinical Diagnosis of Deep Venous Thrombosis

Kahn¹

1998

Arch Intern Med

100

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Symptoms and clinical signs suggestive of deep venous thrombosis (DVT) are common and have numerous possible causes. Studies have shown that symptoms and clinical signs in themselves are inaccurate for the diagnosis of DVT. However, clinicians have other information at hand, such as data on risk factors for DVT, that may help improve their ability to predict a diagnosis of DVT in the individual patient. Epidemiological data on DVT incidence and risk factors were reviewed, as were published data on the accuracy of clinical diagnosis of DVT, with the use of both symptoms and signs in isolation and symptoms and signs combined with other clinical information in the form of clinical prediction indexes. Symptoms and clinical signs, when combined with other patient information such as the presence or absence of known risk factors for DVT, can improve clinical prediction considerably. Further study is needed to determine whether clinical prediction indexes have a role in improving the diagnostic process in patients with suspected DVT.

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Value of assessment of pretest probability of deep-vein thrombosis in clinical management

Cited by 1,092 publications

References 15 publications

A novel method for predicting the risk of thrombosis and thromboembolism

A novel method for predicting the risk of thrombosis and thromboembolism

Guidelines for Venous Thromboembolism and Clinical Practice in Italy: A Nationwide Survey

The Clinical Diagnosis of Deep Venous Thrombosis

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