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Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
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Optimisation of the diagnostic strategy for suspected deep-vein thrombosis in primary care

Kristel J M Janssen1, Eit F van der Velde, Arina J Ten Cate

  • 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. K.J.M.Janssen@umcutrecht.nl

Thrombosis and Haemostasis
|October 2, 2010
PubMed

Insights

A diagnostic score effectively and safely excludes deep-vein thrombosis (DVT) in primary care, reducing referrals by nearly 50% without compromising patient safety. Further adjustments did not improve its accuracy.

Area of Science:

  • Medical Diagnostics
  • Primary Care Medicine
  • Clinical Decision Support

Background:

  • A validated diagnostic score exists to safely exclude deep-vein thrombosis (DVT) in primary care settings.
  • A prospective study demonstrated a 50% reduction in ultrasound referrals for suspected DVT using this score.
  • The study reported an acceptably low risk of 1.4% for venous thromboembolic events in non-referred patients.

Purpose of the Study:

  • To evaluate if updating the existing DVT diagnostic score could further enhance its accuracy.
  • To assess if adjusting predictor weights or adding new predictors improves diagnostic safety and efficiency.
  • To determine the optimal diagnostic strategy for excluding DVT in primary care.

Main Methods:

  • Two updating methods were applied to the diagnostic score: adjusting predictor weights and adding new predictors.
  • Predictive value of 'history of DVT' and 'prolonged travelling' was assessed.
  • Safety (missed diagnoses rate) and efficiency (referral reduction) were compared between the original and updated scores.

Main Results:

  • Adjusting predictor weights was unnecessary.
  • Inclusion of 'history of DVT' and 'prolonged travelling' added significant predictive value (p<0.05).
  • However, updated scores did not improve safety or efficiency; at equal safety, efficiency was lower.

Conclusions:

  • The original diagnostic score for excluding DVT in primary care demonstrates good accuracy and safety.
  • Updating the score with additional predictors did not yield further improvements in diagnostic performance.
  • The original diagnostic score is recommended for safe exclusion of clinically suspected DVT in primary care.

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