ORIGINAL ARTICLES   

International Angiology 2000 March;19(1):47-51

Copyright © 2001 EDIZIONI MINERVA MEDICA

lingua: Inglese

Risk factor assessment in the management of patients with suspected deep venous thrombosis

Motykie G. D., Caprini J. A., Arcelus J. I., Zebala L. P., Lee C. E., Finke N. M., Tamhane A., Reyna J. J.

From the Department of Surgery, Evanston Northwestern Healthcare, Evanston IL (USA) * Hospital de la Axarquía, Málaga, Spain, and Northwestern University Medical School, Chicago, IL (USA)

Background. To eval­u­ate the prev­a­lence of throm­bo­sis risk fac­tors in a group of ­patients under­go­ing ­venous ­duplex scan­ning (VDS) and to ­design a risk fac­tor strat­ifi­ca­tion model with the abil­ity to ­improve the diag­nos­tic yield of VDS.
Meth­ods. Risk fac­tor assess­ment and VDS were per­formed on 1,000 ­patients with clin­i­cal­ly sus­pect­ed lower extrem­ity deep vein throm­bo­sis (DVT) and ­patients were divid­ed into two ­groups based upon the out­come of their scan: those with and those with­out con­firmed DVT. Uni­var­i­ate and mul­ti­var­i­ate logis­tic regres­sion anal­y­ses were per­formed in order to deter­mine the sig­nif­i­cance of each risk fac­tor in rela­tion to hav­ing a con­firmed DVT.
­Results. There were 181 ­patients (18.1%) with con­firmed DVT. A prior his­to­ry of DVT/pul­mo­nary embo­lism, malig­nan­cy, prior immo­bil­iza­tion, and age over 70 were the most impor­tant risk fac­tors asso­ciat­ed with hav­ing a DVT con­firmed on VDS. A novel risk fac­tor strat­ifi­ca­tion model was creat­ed uti­liz­ing the odds ­ratios of those fac­tors found to be sig­nif­i­cant and the prev­a­lence of DVT was found to be 92.4% in the high risk cat­e­go­ry, 11.5% in the mod­er­ate risk cat­e­go­ry, and 3.2% in the low risk cat­e­go­ry using this model.
Con­clu­sions. ­Venous ­duplex scan­ning is estab­lished as the screen­ing test of ­choice when one sus­pects the diag­no­sis of DVT ­despite the sig­nif­i­cant cost of per­form­ing and inter­pret­ing the test. We sug­gest that a bet­ter clin­i­cal model uti­liz­ing risk fac­tor assess­ment may be the key to increas­ing the yield rate and cost-effec­tive­ness of VDS by exclud­ing low-risk ­patients from under­go­ing unnec­es­sary test­ing.