Dryjski M, O'Brien-Irr M S, Harris L M, Hassett J, Janicke D
Department of Surgery, State University of New York at Buffalo, Kaleida Health, Millard Fillmore Gates Hospital, 14209, USA.
J Vasc Surg. 2001 Dec;34(6):1010-5. doi: 10.1067/mva.2001.119889.
The purpose of this study was to evaluate the efficacy and cost effectiveness of a deep venous thrombosis (DVT) screening protocol incorporating DVT pretest probability (PTP), selective D-dimer assay, and venous duplex imaging (VDI) to exclude the diagnosis of DVT among emergency department (ED) patients.
A prospective study of all patients evaluated in the ED for suspected DVT during 1 year was undertaken. Patients were classified into PTP risk category by ED physicians before VDI. Correlation studies were completed using VDI as the gold standard. Charges associated with the protocol were calculated.
One hundred fourteen patients were included. The incidence of DVT was 9.6% (11). Thirty-six (55%) patients were classified as high risk, 23 (35%) as moderate, and 7 (10%) as low risk. All patients diagnosed with DVT were in the high-risk group (incidence, 16.7%). The sensitivity and negative predictive value were both 100% when PTP and D-dimer were used, but fell to 80% and 95%, respectively, when only D-dimer was considered. The true negative rates were 23% and 37%, respectively. Based on this study, we propose the following screening: for high-risk patients, use direct VDI (no D-dimer); for low-risk or moderate-risk patients, obtain D-dimer, and if it is positive, use VDI, and if it is negative, no further action is required. The average charge associated with the protocol was 170.50 dollars as opposed to 202.00 dollars for global VDI.
A screening protocol using PTP along with selective D-dimer and VDI to exclude the diagnosis of DVT among ED patients is efficacious and cost efficient. This screening approach establishes criteria to satisfy billing requirements, can eliminate unnecessary VDI in 23% of ED referrals, and can reduce charges by 16%.
本研究旨在评估一种包含深静脉血栓形成（DVT）预测试概率（PTP）、选择性D-二聚体检测和静脉超声成像（VDI）的深静脉血栓筛查方案在排除急诊科（ED）患者DVT诊断方面的有效性和成本效益。
对1年内急诊科评估疑似DVT的所有患者进行前瞻性研究。在进行VDI之前，急诊科医生将患者分类到PTP风险类别。使用VDI作为金标准完成相关性研究。计算与该方案相关的费用。
共纳入114例患者。DVT发生率为9.6%（11例）。36例（55%）患者被分类为高风险，23例（35%）为中度风险，7例（10%）为低风险。所有被诊断为DVT的患者均在高风险组（发生率为16.7%）。当使用PTP和D-二聚体时，敏感性和阴性预测值均为100%，但仅考虑D-二聚体时，分别降至80%和95%。真阴性率分别为23%和37%。基于本研究，我们提出以下筛查方案：对于高风险患者，使用直接VDI（不进行D-二聚体检测）；对于低风险或中度风险患者，检测D-二聚体，若结果为阳性，则使用VDI，若为阴性，则无需进一步检查。该方案的平均费用为170.50美元，而全面VDI检查的费用为202.00美元。
采用PTP联合选择性D-二聚体和VDI排除急诊科患者DVT诊断的筛查方案有效且具有成本效益。这种筛查方法建立了满足计费要求的标准，可在23%的急诊科转诊病例中消除不必要的VDI检查，并可降低费用16%。
