Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, via Albertoni, 15, 40138, Bologna, Italy.
Intern Emerg Med. 2019 Sep;14(6):941-947. doi: 10.1007/s11739-019-02066-8. Epub 2019 Mar 12.
Deep vein thrombosis (DVT) is an important cause of morbidity and mortality in hospitalized patients. The Wells score for DVT pretest probability (PTP) was validated in outpatients, but its utility for inpatients is unclear. The aim of this study was to establish the prevalence of inpatient proximal and distal DVT and the Wells score performance in inpatients. A single-center cross-sectional study was conducted in a university hospital. During 183 days, all inpatients with suspected lower-extremity DVT were evaluated with the Wells score and whole-leg ultrasound. Among 634 inpatients (age 77.5 ± 13.8 years, males 39.3%), 507 (80.0%) were from medical wards and 127 (20.0%) from surgical wards. During the study period, there were 11,662 hospital admissions in the surgical/medical services. Whole-leg ultrasound detected 128 DVTs (20.2%); 51 (39.8%) were proximal and 77 (60.1%) were isolated distal DVTs. Estimated DVT prevalence in hospital setting was 1.09% (95% CI 0.93-1.31), and isolated distal DVT prevalence was 0.66% (95% CI 0.53-0.82). DVT frequency in low-, moderate-, and high-PTP groups was 9.8%, 24.3%, and 41.5%, respectively (p = 0.001). The area under the receiver operating characteristic curve for the Wells score was 0.67 ± 0.03 for all DVTs and 0.75 ± 0.04 for only proximal DVTs. A high PTP had a sensitivity of 24% (95% CI 14-37%) and a specificity of 93% (95% CI 91-95%) for proximal DVT diagnosis. In hospitalized patients, isolated distal DVT has a higher incidence than expected, and the Wells score accuracy for proximal DVT is similar to that found in outpatients.
深静脉血栓形成（DVT）是住院患者发病率和死亡率的重要原因。DVT 预测概率（PTP）的 Wells 评分已在门诊患者中得到验证，但它在住院患者中的应用尚不清楚。本研究旨在确定住院患者近端和远端 DVT 的患病率以及 Wells 评分在住院患者中的表现。这是一项在一所大学医院进行的单中心横断面研究。在 183 天内，所有疑似下肢 DVT 的住院患者均接受了 Wells 评分和全腿超声检查。在 634 名住院患者中（年龄 77.5±13.8 岁，男性 39.3%），507 名（80.0%）来自内科病房，127 名（20.0%）来自外科病房。在研究期间，外科/内科服务共收治了 11662 名住院患者。全腿超声检查发现 128 例 DVT（20.2%）；51 例（39.8%）为近端 DVT，77 例（60.1%）为孤立的远端 DVT。估计医院环境中的 DVT 患病率为 1.09%（95%CI 0.93-1.31），孤立的远端 DVT 患病率为 0.66%（95%CI 0.53-0.82）。低、中、高 PTP 组的 DVT 发生率分别为 9.8%、24.3%和 41.5%（p=0.001）。Wells 评分对所有 DVT 的曲线下面积为 0.67±0.03，对仅近端 DVT 的曲线下面积为 0.75±0.04。高 PTP 对近端 DVT 的诊断敏感性为 24%（95%CI 14-37%），特异性为 93%（95%CI 91-95%）。在住院患者中，孤立的远端 DVT 的发病率高于预期，而 Wells 评分对近端 DVT 的准确性与在门诊患者中发现的相似。
