Vascular Medicine Department, University Hospital Poitiers, Poitiers, France.
Vascular Medicine Department, University Hospital Nîmes, Nîmes, Languedoc-Roussillon, France.
Vasc Med. 2021 Jun;26(3):288-296. doi: 10.1177/1358863X21994672. Epub 2021 Mar 22.
The Wells score had shown weak performance to determine pre-test probability of deep vein thrombosis (DVT) for inpatients. So, we evaluated the impact of thromboprophylaxis on the utility of the Wells score for risk stratification of inpatients with suspected DVT. This bicentric cross-sectional study from February 1, 2018 to January 31, 2019 included consecutive medical and surgical inpatients who underwent lower limb ultrasound study for suspected DVT. Wells score clinical predictors were assessed by both ordering and vascular physicians within 24 h after clinical suspicion of DVT. Primary outcome was the Wells score's accuracy for pre-test risk stratification of suspected DVT, accounting for anticoagulation (AC) treatment (thromboprophylaxis for ⩾ 72 hours or long-term anticoagulation). We compared prevalence of proximal DVT among the low, moderate and high pre-test probability groups. The discrimination accuracy was defined as area under the receiver operating characteristics (ROC) curve. Of the 415 included patients, 30 (7.2%) had proximal DVT. Prevalence of proximal DVT was lower than expected in all pre-test probability groups. The prevalence in low, moderate and high pre-test probability groups was 0.0%, 3.1% and 8.2% ( = 0.22) and 1.7%, 4.2% and 25.8% ( < 0.001) for inpatients with or without AC, respectively. Area under ROC curves for discriminatory accuracy of the Wells score, for risk of proximal DVT with or without AC, was 0.72 and 0.88, respectively. The Wells score performed poorly for discrimination of risk for proximal DVT in hospitalized patients with AC but performed reasonably well among patients without AC; and showed low inter-rater reliability between physicians.
威尔斯评分在预测住院患者深静脉血栓（DVT）的术前患病概率方面表现不佳。因此，我们评估了血栓预防措施对 Wells 评分用于疑似 DVT 住院患者风险分层的影响。这是一项 2018 年 2 月 1 日至 2019 年 1 月 31 日进行的、包含连续住院患者的、以中心为基础的、前瞻性研究，这些患者因疑似 DVT 而行下肢超声检查。在怀疑 DVT 后 24 小时内，临床医生和血管科医生都评估了 Wells 评分的临床预测因素。主要结果是 Wells 评分对疑似 DVT 的术前风险分层的准确性，同时考虑了抗凝治疗（AC）（≥72 小时的血栓预防或长期抗凝）。我们比较了低、中、高术前概率组中近端 DVT 的发生率。区分准确性定义为接受者操作特征（ROC）曲线下面积。在 415 例纳入患者中，有 30 例（7.2%）患有近端 DVT。在所有术前概率组中，近端 DVT 的发生率均低于预期。在有或无 AC 的低、中、高术前概率组中，近端 DVT 的发生率分别为 0.0%、3.1%和 8.2%（=0.22）和 1.7%、4.2%和 25.8%（<0.001）。在有或无 AC 的情况下，ROC 曲线下面积分别为 0.72 和 0.88，用于预测近端 DVT 的 Wells 评分的区分准确性。威尔斯评分在预测有或无 AC 的住院患者近端 DVT 风险时表现不佳，但在无 AC 的患者中表现相当好；并且两位医生之间的评分一致性较差。
