Deferment of Objective Assessment of Deep Vein Thrombosis and Pulmonary Embolism Without Increased Risk of Thrombosis (original) (raw)

The management of deep vein thrombosis: the Autar DVT risk assessment scale re-visited

Journal of Orthopaedic Nursing, 2003

Deep vein thrombosis (DVT) is a precursor of potentially fatal pulmonary embolism (PE). The Autar DVT scale (1994) was developed to assess patient risk and enable the application of the most effective prophylaxis. The scale is composed of seven categories of risk factors derived from Virchow's triad. The DVT scale was re-evaluated on 150 patients across three distinct clinical specialities to allow for generalisation of the findings. Five reproducibility studies achieved total percentage agreement of between 91 and 98%, j values within 0.88-0.95 and intra-class correlation coefficients of 0.94-0.99, confirming the consistency of the instrument. A receiver operating characteristic (ROC) curve was constructed to determine the optimal predictive accuracy of the scale and a cut-off score of 11 yielded approximately 70% sensitivity. Partially completed data from two patients were excluded from the sensitivity analysis of the DVT scale. Out of the 148 (78%) 115 patients were correctly predicted. However, the predictive accuracy of the DVT scale was partially masked by the 50% of patients who were recipient of some proven venous thromboprophylaxis.

DVT and Pulmonary Embolism: Part I. Diagnosis

2004

The incidence of venous thromboembolic diseases is increasing as the U.S. population ages. At least one established risk factor is present in approximately 75 percent of patients who develop these diseases. Hospitalized patients and nursing home residents account for one half of all cases of deep venous thrombosis. A well-validated clinical prediction rule can be used for risk stratification of patients with suspected deep venous thrombosis. Used in combination with D-dimer or Doppler ultrasound tests, the prediction rule can reduce the need for contrast venography, as well as the likelihood of false-positive or false-negative test results. The inclusion of helical computed tomographic venography (i.e., a below- the-pelvis component) in pulmonary embolism protocols remains under evaluation. Specific combina- tions of a clinical prediction rule, ventilation-perfusion scanning, and D-dimer testing can rule out pul- monary embolism without an invasive or expensive investigation. A clin...

Simplification of the Diagnostic Management of Suspected Deep Vein Thrombosis

Archives of Internal Medicine, 2002

The standard diagnostic approach in patients with suspected deep vein thrombosis is to repeat the compression ultrasonography after 1 week in all patients with an initial normal result. We hypothesized that a normal finding of a D-dimer assay safely obviates the need for repeated ultrasonography. In addition, we evaluated the potential value of a pretest probability assessment for this purpose.