Medical Department 2, Municipal Hospital Friedrichstadt, Dresden, Germany.
Thromb Haemost. 2009 Dec;102(6):1234-40. doi: 10.1160/TH09-06-0385.
Current guidelines recommend optimised algorithms for diagnosis of suspected deep-vein thrombosis (DVT). There is little data to determine to what extent real-world health care adheres to guidelines, and which outcome in terms of diagnostic efficiency and safety is achieved. This registry involved patients with clinically suspected DVT of the leg recruited in German ambulatory care between October and December 2005. Registry items were: diagnostic methods applied, diagnostic categories at day 1, and venous thromboembolic events up to 90 days in patients without firmly established DVT. A total of 4,976 patients were recruited in 326 centres. Venous ultrasonography was performed in 4,770 patients (96%), D-dimer assay in 1,773 patients (36%) and venography in 288 patients (6%). At day 1, DVT was confirmed in 1,388 patients (28%), and ruled out in 3,389 patients (68%), and work-up was inconclusive in 199 patients (4%). The rate of venous thromboembolism at 90 days was 0.34% (95% confidence interval [CI]: 0.09 to 0.88) in patients in whom the diagnosis of DVT had been ruled out, and 2.50% (95% CI: 0.69 to 6.28) in patients with inconclusive diagnostic workup. This nationwide evaluation in German ambulatory care revealed that the diagnostic work-up for suspected DVT did not adhere to current guidelines. However, the overall diagnostic safety was excellent, although there is potential for improvement in a well defined minority of patients.
目前的指南建议优化算法以诊断疑似深静脉血栓形成（DVT）。很少有数据可以确定在多大程度上实际医疗保健符合指南，以及在诊断效率和安全性方面达到了哪些效果。该登记研究纳入了 2005 年 10 月至 12 月在德国门诊就诊的疑似下肢 DVT 的患者。登记项目包括：应用的诊断方法、第 1 天的诊断类别以及在未明确诊断 DVT 的患者中 90 天内的静脉血栓栓塞事件。共在 326 个中心招募了 4976 例患者。对 4770 例患者（96%）进行了静脉超声检查，对 1773 例患者（36%）进行了 D-二聚体检测，对 288 例患者（6%）进行了静脉造影。第 1 天，1388 例（28%）患者确诊 DVT，3389 例（68%）患者排除 DVT，199 例（4%）患者诊断结果不确定。在排除 DVT 诊断的患者中，90 天静脉血栓栓塞症的发生率为 0.34%（95%可信区间：0.09 至 0.88），在诊断结果不确定的患者中为 2.50%（95%可信区间：0.69 至 6.28）。德国门诊的这项全国性评估显示，疑似 DVT 的诊断性检查并未遵循当前的指南。然而，整体诊断安全性非常好，尽管在明确的少数患者中仍有改进的空间。
