Evaluation of the new simple and objective clinical decision rule "I-DVT" in patients with clinically suspected acute deep vein thrombosis. Issue 141 (May 2016)

• Record Type: Journal Article
• Authors: Dronkers, Charlotte E.A.; Tan, Melanie; Mol, Gerben C.; Iglesias del Sol, Antonio; van de Ree, Marcel A.; Huisman, Menno V.; Klok, Frederikus A.
• Is Part Of: Thrombosis research. Issue 141(2016)
• Page Start: 112
• Page End: 118
• Publication Date: 2016-05
• Subjects: AUC area under the (ROC) curve -- CDR clinical decision rule -- CTPA computed tomography pulmonary angiography -- CUS compression ultrasonography -- DVT deep vein thrombosis -- PE pulmonary embolism -- ROC curve(receiver operating characteristic curve) -- VTE venous thromboembolism; Venous thrombosis -- Decision support techniques -- Diagnosis -- Fibrin fibrinogen degradation products -- Clinical decision rule; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2016.03.016
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: The Wells rule is the recommended first step in the work-up of suspected deep vein thrombosis (DVT). However, it is often incorrectly used leading to an excessive number of diagnostic tests used in daily practice and diagnostic failures. A simpler objective risk stratification tool may improve adherence to the guidelines. We evaluated the diagnostic performance of the I-DVT score, which consists of four easy assessable variables:I mmobilization, > 3 cmD ifference in calve circumferences, priorV enous thromboembolism (VTE) and active malignantT umor. Methods: We performed an observational study in 617 consecutive patients with suspected DVT. All patients were managed according to the recommended algorithm starting with the Wells rule followed by D-dimer test and/or compression ultrasonography (CUS). The I-DVT score was prospectively calculated at baseline and evaluated post-hoc. Results: The DVT prevalence was 36%. DVT could be excluded in 13% of patients without CUS by the Wells rule and a normal D-dimer test, with a 3-month VTE incidence of 1.2% (95%CI 0.03–6.5%). Using the I-DVT score, DVT would have been excluded in 9.1% of patients without additional CUS, with a 3-month VTE incidence of 0% (95%CI 0.0–6.4%). The area under the ROC curve (AUC) was 0.70 (95%CI 0.66–0.74) and 0.65 (95%CI 0.61–0.70) for the Wells rule and I-DVT score respectively (difference 0.049, 95%CI − 0.01–0.11; p = 0.13). Conclusions: The simple I-DVT score and Wells rule have comparable diagnostic accuracy. It's safety, efficiency and associated potential improvement of guideline adherence in clinical practice has to be further evaluated in a prospective management study. Highlights: The Wells rule for DVT is often incorrectly used, mainly due to its length. The I-DVT score is a simple and objective score consisting of four variables. The simple I-DVT score and Wells rule have comparable diagnostic accuracy. Safety and efficiency of the I-DVT score has to be further evaluated.