Diagnostic Utility of Clinical Scoring System and D-Dimer Assay in Suspected Cerebral Venous Thrombosis: A...

This study aimed to evaluate the diagnostic accuracy of a clinical scoring system, both alone and in combination with D-dimer assay, for suspected cerebral venous thrombosis (CVT) in the emergency department.

This prospective observational study was conducted in the Emergency Department of a tertiary care teaching hospital in India. Patients who met the inclusion criteria were assessed using a CVT scoring system. They underwent non-contrast computed tomogography of the brain to rule out other types of strokes and to detect signs of CVT. D-dimer testing was also performed. The diagnosis of CVT was subsequently confirmed by magnetic resonance venography (MRV).

Among the75 study subjects, the frequency of CVT, as confirmed by MRV, was 53.33%. Elevated D-dimer levels were observed in 32 out of 75 patients, of whom 26 (65%) patients had CVT. A low-probability clinical score demonstrated a sensitivity of 73.33% and a pecificity of 71.1% for ruling out CVT. When a low-probability score was combined with D-dimer values below 500 μg/L, the sensitivity for ruling out CVT improved to 92.5%.

The present study indicated that moderate- and high-probability clinical scores were associated with a higher likelihood of CVT. In this cohort, a low-probability clinical score combined with a negative D-dimer assay had a high negative predictive value for CVT. While a moderate or high-probability score warranted urgent imaging, it could not confirm the diagnosis on its own. This approach is particularly useful in resource-limited settings for triaging and referring patients for the early initiation of treatment.