Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Department of Pathology, College of medicine, Qassim University, Buraidah, Saudi Arabia.
Thromb J. 2014 Nov 28;12(1):28. doi: 10.1186/s12959-014-0028-7. eCollection 2014.
Venous thromboembolism (VTE) requires urgent diagnosis and treatment to avoid related complications. Clinical presentations of VTE are nonspecific and require definitive confirmation by imaging techniques. A clinical pretest probability (PTP) score system helps predict VTE and reduces the need for costly imaging studies. d-dimer (DD) assay has been used to screen patients for VTE and has shown to be specific for VTE. The combined use of PTP and DD assay may improve exclusion of VTE and safely avoid imaging studies.
We prospectively used the Wells PTP score and a DD test to evaluate 230 consecutive patients who presented with VTE symptoms. The receiver operating characteristic curve was used to identify a new DD cutoff value, which was applied to VTE diagnosis and compared with the upper limit of locally established reference range for prediction of thrombosis alone and in combination with the clinical PTP score.
We evaluated 118 patients with VTE symptoms fulfilling the inclusion criteria, 64 (54.2%) with clinically suspected deep vein thrombosis (DVT) and 54 (45.8%) with symptoms of pulmonary embolism (PE). The PTP was low in 28 (43.8%) and moderate/high in 36 (56.25%) of the suspected DVT patients, and low in 29 (53.7%) and moderate/high in 25 (46.3%) of the suspected PE patients. Eighteen cases were confirmed by imaging studies: 9 DVT and 9 PE. The agreement between confirmed cases and PTP was significant with PE but not DVT. The negative predictive value for both DVT and PE with current DD cutoff value of <250 μg/L DDU was 100%, whereas with the calculated cutoff the NPV was 88%.
We confirm that PTP score is valuable tool for medical residents to improve the detection accuracy of VTE, especially for PE. The DD cutoff value of 250 μg/L FEU is ideal for excluding most cases of low PTP; however, the calculated cutoff was less specific for the exclusion of VTE.
静脉血栓栓塞症（VTE）需要紧急诊断和治疗，以避免相关并发症。VTE 的临床表现不具有特异性，需要通过影像学技术进行明确诊断。临床预测试验概率（PTP）评分系统有助于预测 VTE，并减少昂贵的影像学检查的需求。D-二聚体（DD）检测已被用于筛查 VTE 患者，且被证明对 VTE 具有特异性。PTP 和 DD 联合检测可能提高 VTE 的排除率，并安全避免影像学检查。
我们前瞻性地使用 Wells PTP 评分和 DD 检测评估了 230 例有 VTE 症状的连续患者。我们使用受试者工作特征曲线来确定新的 DD 截断值，并将其应用于 VTE 诊断，并与当地建立的血栓形成单独和与临床 PTP 评分联合的参考范围上限进行比较。
我们评估了 118 例符合纳入标准的 VTE 症状患者，其中 64 例（54.2%）有临床疑似深静脉血栓形成（DVT），54 例（45.8%）有肺栓塞（PE）症状。疑似 DVT 患者中，PTP 低的有 28 例（43.8%），中/高的有 36 例（56.25%）；疑似 PE 患者中，PTP 低的有 29 例（53.7%），中/高的有 25 例（46.3%）。18 例经影像学检查证实：9 例 DVT 和 9 例 PE。PE 病例与 PTP 之间的一致性显著，但 DVT 病例无显著差异。目前将 DD 截断值<250μg/L DDU 用于 DVT 和 PE 时，阴性预测值均为 100%，而用计算的截断值时，阴性预测值分别为 88%。
我们证实 PTP 评分是住院医师提高 VTE 检测准确性的有用工具，特别是对 PE。DD 截断值为 250μg/L FEU 理想用于排除低 PTP 大多数病例；然而，计算出的截断值对 VTE 的排除特异性较低。
