SLR - August 2009 - Jahangir Habib
Reference:
Büller, H.R., ten Cate-Hoek, A.J., Hoes, A.W., Joore, M.A., Moons, K.G.M., et al. (2009). Safely ruling out deep venous thrombosis in primary care. Annals of Internal Medicine, 150(4), 229-235.
Scientific Literature Reviews
Reviewed by: Jahangir Habib, DPM
Residency Program: OCPM-UHHS Richmond Medical Center
Podiatric Relevance:
This study describes how to use a clinical decision rule that includes a point-of-care Ddimer assay at initial presentation in primary care to exclude DVT.
Methods:
One thousand twenty-eight consecutive patients with clinically suspected DVT were included in the study. Patients were managed on the basis of the result of the clinical
decision rule, which included a D-dimer result. Patients with a score of 3 or less were not referred for ultrasonography and received no anticoagulant treatment. Patients with a score of 4 or more were referred for ultrasonography.
Results:
The mean age of the 1028 study patients was 58 years, and 37% of patients were men. A valid score was obtained in 1002 patients (98%). In 500 patients (49%), with a score of 3 or less, 7 developed venous thromboembolism within 3 months (incidence 1.4%). A total of 502 patients (49%) had a score of 4 or more; 3 did not have ultrasonography. Ultrasonography showed DVT in 125 patients (25%), for an overall prevalence in evaluable patients of 13% (125 of 1002). Of the 374 patients who had normal ultrasonography results, 4 developed venous thromboembolism within 3 months (1.1%).
Conclusions:
A diagnostic management strategy in primary care by using a simple clinical decision rule and a point-of-care D-dimer assay reduces the need for referral to secondary care of patients with clinically suspected DVT by almost 50%, and is associated with a low risk for subsequent venous thromboembolic events.