Zaleski Amanda L, Taylor Beth A, Pescatello Linda S, Thompson Paul D, Denegar Craig
a Department of Kinesiology , University of Connecticut , Storrs , CT , USA.
b Henry Low Heart Center, Department of Cardiology , Hartford Hospital , Hartford , CT , USA.
Phys Sportsmed. 2017 Nov;45(4):358-364. doi: 10.1080/00913847.2017.1355210. Epub 2017 Jul 21.
There are an increasing number of reports describing deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in otherwise healthy endurance athletes. The Wells score is the most commonly used clinical prediction rule to diagnose DVT/PE in clinical populations. However, the Wells score may have limited utility for recognition of DVT/PE in athletes, contributing to missed or delayed diagnosis.
We performed an analysis of the ability of the Wells score to identify DVT/PE events in athletes through a review of published case reports.
A systematic search of the literature yielded 11 case reports.
The Wells score had a 100% failure rate in identifying athletes with DVT (0/6) and PE (0/5), resulting in a delayed diagnosis for DVT of 20 ± 14 days. Retrospectively removing 'differential diagnosis' from the clinical prediction rule for DVT changed the Wells score median from 0 (range: -1 to 0) to 2 (range: 1 to 2); the threshold for predicting DVT as 'likely'. There were limited clinical characteristics captured in the Wells score for PE that were applicable to athletes, highlighting the need for reappraisal. Although the Wells score failed to accurately triage athletes with known DVT and/or PE, the addition of a D-dimer value (mean: 1566 ± 758ng/dL) to the Wells score correctly identified 9/9 athletes.
The Wells score had a 100% failure rate for triaging athletes with known DVT/PE. When performed, D-dimer adequately facilitated the additional diagnostic testing required for a timely diagnosis of DVT/PE in athletes. Improving awareness of an atypical presentation of thrombotic events in athletes may reduce the widespread underestimation of DVT/PE among athletes and facilitate the additional testing required for a timely diagnosis.
越来越多的报告描述了原本健康的耐力运动员发生深静脉血栓形成（DVT）和/或肺栓塞（PE）的情况。Wells评分是临床人群中诊断DVT/PE最常用的临床预测规则。然而，Wells评分在识别运动员的DVT/PE方面可能效用有限，导致漏诊或诊断延迟。
我们通过回顾已发表的病例报告，分析Wells评分识别运动员DVT/PE事件的能力。
对文献进行系统检索，得到11份病例报告。
Wells评分在识别患有DVT（0/6）和PE（0/5）的运动员时失败率为100%，导致DVT诊断延迟20±14天。回顾性地从DVT临床预测规则中去除“鉴别诊断”，使Wells评分中位数从0（范围：-1至0）变为2（范围：1至2）；这是将DVT预测为“可能”的阈值。Wells评分中适用于运动员的PE临床特征有限，凸显了重新评估的必要性。尽管Wells评分未能准确对已知患有DVT和/或PE的运动员进行分类，但在Wells评分中加入D-二聚体值（平均值：1566±758ng/dL）可正确识别9/9名运动员。
Wells评分在对已知患有DVT/PE的运动员进行分类时失败率为100%。进行D-二聚体检测能充分促进对运动员进行DVT/PE及时诊断所需的额外诊断检测。提高对运动员血栓形成事件非典型表现的认识，可能会减少运动员中对DVT/PE普遍存在的低估情况，并有助于及时诊断所需的额外检测。
