Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Haematology, Oslo University Hospital, Oslo, Norway.
Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
Thromb Res. 2019 Dec;184:62-66. doi: 10.1016/j.thromres.2019.10.018. Epub 2019 Oct 25.
The Villalta scale is currently the recommended tool for diagnosing post-thrombotic syndrome (PTS) in clinical studies, but there is concern that the sensitivity and specificity of the scale might be low. We aimed to evaluate the diagnostic accuracy of the Villata scale using criteria in line with clinical practice as a reference.
We invited patients with a history of proximal DVT during 2006-09 to participate in a cross-sectional follow-up study of long-term complications after DVT. PTS was diagnosed by the Villalta scale, and by the following four mandatory and predefined clinical criteria used as a reference for PTS: 1. Objectively verified DVT; 2. chronic complaints (>1 month) in the DVT leg; 3. complaints appeared after the DVT; and 4. an alternative diagnosis was unlikely.
We included 88 of 170 eligible patients (52%). With our clinical criteria as a reference the sensitivity and specificity of the Villalta scale for diagnosing PTS were 75% (95% CI 60-87%) and 66% (95% CI 50-80%), respectively. Fifteen patients were diagnosed with PTS by the Villalta scale only. These patients more often experienced pain or had comorbidity that could explain their leg symptoms and signs. Eleven patients diagnosed with PTS by the clinical criteria only, had more fluctuating heaviness and edema.
Our findings indicate that the diagnostic accuracy of the Villalta scale has limitations. Incorporating chronicity, whether the leg problems appeared following the DVT, fluctuations of heaviness and edema, and comorbidity in PTS assessment may improve the diagnostic accuracy.
目前，Villalta 量表是用于临床研究中诊断血栓后综合征（PTS）的推荐工具，但人们担心该量表的敏感性和特异性可能较低。我们旨在使用符合临床实践的标准评估 Villata 量表的诊断准确性作为参考。
我们邀请了 2006-09 年间患有近端深静脉血栓形成（DVT）病史的患者参加一项 DVT 后长期并发症的横断面随访研究。PTS 采用 Villalta 量表进行诊断，并采用以下四个强制性和预先定义的临床标准作为 PTS 的参考：1. 客观证实的 DVT；2. DVT 肢体存在慢性症状（>1 个月）；3. 症状出现在 DVT 之后；4. 不太可能存在其他诊断。
我们纳入了 170 名符合条件的患者中的 88 名（52%）。以我们的临床标准作为参考，Villalta 量表诊断 PTS 的敏感性和特异性分别为 75%（95%CI 60-87%）和 66%（95%CI 50-80%）。15 名患者仅被 Villalta 量表诊断为 PTS。这些患者更常经历疼痛或存在可能解释其腿部症状和体征的合并症。11 名仅根据临床标准诊断为 PTS 的患者，腿部沉重感和肿胀的波动性更大。
我们的研究结果表明，Villalta 量表的诊断准确性存在局限性。在 PTS 评估中纳入慢性、腿部问题是否在 DVT 之后出现、沉重感和肿胀的波动性以及合并症，可能会提高诊断准确性。
