Oudega Ruud, Moons Karel G M, Hoes Arno W
Julius Center for Health Sciences and Primary care, University Medical Center, Utrecht, The Netherlands.
Thromb Haemost. 2005 Jul;94(1):200-5. doi: 10.1160/TH04-12-0829.
In primary care, the physician has to decide which patients have to be referred for further diagnostic work-up. At present, only in 20% to 30% of the referred patients the diagnosis DVT is confirmed. This puts a burden on both patients and health care budgets. The question arises whether the diagnostic work-up and referral of patients suspected of DVT in primary care could be more efficient. A simple diagnostic decision rule developed in primary care is required to safely exclude the presence of DVT in patients suspected of DVT, without the need for referral. In a cross-sectional study, we investigated the data of 1295 consecutive patients consulting their primary care physician with symptoms suggestive of DVT, to develop and validate a simple diagnostic decision rule to safely exclude the presence of DVT. Independent diagnostic indicators of the presence of DVT were male gender, oral contraceptive use, presence of malignancy, recent surgery, absence of leg trauma, vein distension, calf difference and D-dimer test result. Application of this rule could reduce the number of referrals by at least 23% while only 0.7% of the patients with a DVT would not be referred. We conclude that by using eight simple diagnostic indicators from patient history, physical examination and the result of D-dimer testing, it is possible to safely rule out DVT in a large number of patients in primary care, reducing unnecessary patient burden and health care costs.
在初级保健中，医生必须决定哪些患者需要转诊以进行进一步的诊断检查。目前，在转诊患者中只有20%至30%被确诊为深静脉血栓形成（DVT）。这给患者和医疗保健预算都带来了负担。问题在于，初级保健中对疑似DVT患者的诊断检查和转诊是否可以更高效。需要制定一个在初级保健中开发的简单诊断决策规则，以安全地排除疑似DVT患者中存在DVT的情况，而无需转诊。在一项横断面研究中，我们调查了1295例连续因疑似DVT症状而咨询初级保健医生的患者的数据，以制定和验证一个简单的诊断决策规则，以安全地排除DVT的存在。DVT存在的独立诊断指标包括男性、使用口服避孕药、存在恶性肿瘤、近期手术、无腿部创伤、静脉扩张、小腿差异和D - 二聚体检测结果。应用此规则可将转诊数量至少减少23%，而只有0.7%的DVT患者不会被转诊。我们得出结论，通过使用患者病史、体格检查和D - 二聚体检测结果中的八个简单诊断指标，可以在初级保健中安全地排除大量患者的DVT，减少不必要的患者负担和医疗保健成本。
