Comparison of empirical estimate of clinical pretest probability with the Wells score for diagnosis of deep vein thrombosis

作者：Wang Bo; Lin Yin; Pan Fu shun; Yao Chen; Zheng Zi yu; Cai Dan; Xu Xiang dong^*

来源：Blood Coagulation and Fibrinolysis: international journal in haemostasis and thrombosis , 2013, 24(1): 76-81.

DOI：10.1097/MBC.0b013e32835aba49

• D-dimer
• deep vein thrombosis
• empirical estimation
• pretest probability
• Wells score

Wells score has been validated for estimation of pretest probability in patients with suspected deep vein thrombosis (DVT). In clinical practice, many clinicians prefer to use empirical estimation rather than Wells score. However, which method is better to increase the accuracy of clinical evaluation is not well understood. Our present study compared empirical estimation of pretest probability with the Wells score to investigate the efficiency of empirical estimation in the diagnostic process of DVT. Five hundred and fifty-five patients were enrolled in this study. One hundred and fifty patients were assigned to examine the interobserver agreement for Wells score between emergency and vascular clinicians. The other 405 patients were assigned to evaluate the pretest probability of DVT on the basis of the empirical estimation and Wells score, respectively, and plasma D-dimer levels were then determined in the low-risk patients. All patients underwent venous duplex scans and had a 45-day follow up. Weighted Cohen's kappa value for interobserver agreement between emergency and vascular clinicians of the Wells score was 0.836. Compared with Wells score evaluation, empirical assessment increased the sensitivity, specificity, Youden's index, positive likelihood ratio, and positive and negative predictive values, but decreased negative likelihood ratio. In addition, the appropriate D-dimer cutoff value based on Wells score was 175 mu g/l and 108 patients were excluded. Empirical assessment increased the appropriate D-dimer cutoff point to 225 mu g/l and 162 patients were ruled out. Our findings indicated that empirical estimation not only improves D-dimer assay efficiency for exclusion of DVT but also increases clinical judgement accuracy in the diagnosis of DVT.

• 单位
  1; 中山大学