Department of Medicine, Great Western Hospital, Swindon SN3 6BB, UK.
QJM. 2010 Apr;103(4):259-64. doi: 10.1093/qjmed/hcq007. Epub 2010 Feb 25.
Although deep vein thromboses (DVTs) are common, only a minority of patients referred with suspected DVT will have the condition. Various strategies exist to allow rapid and safe discharge of low-risk patients, thus precluding the need for imaging.
We aimed to investigate the accuracy of clinical risk assessment, D-Dimer analysis, computerized strain gauge plethysmography (CSGP) or a combination of the above in the assessment of outpatients with suspected DVT.
We performed a prospective cohort study on outpatients referred with suspected DVT to our medical assessment unit. Patients systematically underwent clinical risk assessment, D-Dimer analysis, CSGP and imaging with ultrasonography and/or venography.
One hundred and eighty patients with suspected DVT were included in the analysis. Using a threshold of 0.6 mg/l, D-Dimer had a sensitivity and negative predictive value (NPV) of 100% for detecting DVT. Incorporating D-Dimer analysis with clinical risk assessment increased the specificity of the test. The sensitivity and NPV of CSGP were poor at 52.8 and 86.7%, respectively. Incorporating CSGP with D-Dimer did not influence decision making. Although the sensitivity of CSGP was higher for above knee (73.7%) than below knee DVT (29.4%), neither was sufficient for use as a screening tool.
Our study did not support the role of CSGP either as a stand-alone screening tool or in conjunction with clinical risk scoring. As the evidence base for CSGP is conflicting, its accuracy should first be assessed before being incorporated into hospital algorithms as a DVT exclusion tool. However, our results support the current practice for D-Dimer use either alone or in conjunction with clinical assessment tool in the assessment of lower limb DVT.
深静脉血栓（DVT）虽然常见，但只有少数疑似 DVT 的患者会出现这种情况。目前存在多种策略，可以让低风险患者快速、安全地出院，从而无需进行影像学检查。
我们旨在研究临床风险评估、D-二聚体分析、计算机应变计容积描记法（CSGP）或上述方法的组合在评估疑似 DVT 的门诊患者中的准确性。
我们对因疑似 DVT 而到我们的医学评估部门就诊的门诊患者进行了前瞻性队列研究。患者系统地接受了临床风险评估、D-二聚体分析、CSGP 以及超声和/或静脉造影检查。
180 例疑似 DVT 的患者纳入分析。使用 0.6mg/l 的阈值，D-二聚体对 DVT 的敏感性和阴性预测值（NPV）为 100%。将 D-二聚体分析与临床风险评估相结合提高了该测试的特异性。CSGP 的敏感性和 NPV 分别为 52.8%和 86.7%，均较差。将 CSGP 与 D-二聚体结合使用并未影响决策。尽管 CSGP 对膝上（73.7%）DVT 的敏感性高于膝下（29.4%），但均不足以作为筛查工具。
我们的研究不支持 CSGP 作为单独的筛查工具或与临床风险评分结合使用。由于 CSGP 的证据基础存在争议，因此在将其纳入医院算法作为 DVT 排除工具之前，应首先评估其准确性。然而，我们的结果支持目前在评估下肢 DVT 时单独使用 D-二聚体或与临床评估工具结合使用的做法。
