Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Vascular Surgery, Noordwest-Ziekenhuisgroep, Alkmaar, The Netherlands.
J Thromb Haemost. 2022 Aug;20(8):1880-1886. doi: 10.1111/jth.15767. Epub 2022 Jun 20.
Primary deep vein thrombosis of the upper extremity (UEDVT) is a rare condition but up to 60% of patients may develop post-thrombotic syndrome in the upper extremity (UE-PTS) with significant morbidity and decreased quality of life. However, there is no universally accepted method to diagnose and classify UE-PTS, hampering scientific research on UEDVT treatment. Through this international Delphi consensus study we aimed to determine what a clinical score for diagnosing UE-PTS should entail.
An online focus group survey among 20 patients treated for UEDVT was performed to provide clinical parameters before the start of a four round electronic Delphi consensus study among 25 international experts. The CREDES recommendations on Conducting and Reporting Delphi Studies were applied. Open text questions, multiple selection questions, and 9-point Likert scales were used. Consensus was set at 70% agreement.
After four rounds, agreement was reached on a composite score of five symptoms and three clinical signs, combined with a functional disability score. The signs and symptom will each be scored on a severity scale of 0-3 and the total score expressed as an ordinal variable; no/mild/moderate/or severe PTS. The functional disability portion measures the impact of the signs and symptoms on the functionality of the patient's arm.
Consensus was reached on a composite score of signs and symptoms of UE-PTS combined with a functional disability score. Clinical validation of the UE-PTS score in a large patient cohort is mandatory to facilitate application in future research.
上肢深静脉血栓形成（UEDVT）较为少见，但多达 60%的患者可能在上肢发生血栓后综合征（UE-PTS），从而导致较高的发病率和生活质量下降。然而，目前尚无普遍接受的方法来诊断和分类 UE-PTS，这阻碍了对 UEDVT 治疗的科学研究。通过这项国际性的 Delphi 共识研究，我们旨在确定用于诊断 UE-PTS 的临床评分应包含哪些内容。
在开始进行四轮电子 Delphi 共识研究之前，对 20 名接受 UEDVT 治疗的患者进行了在线焦点小组调查，为 25 名国际专家提供了临床参数。采用了 CREDES 对 Delphi 研究的进行和报告的建议。使用了开放式文本问题、多项选择题和 9 点 Likert 量表。共识设定为 70%的同意率。
经过四轮，就五项症状和三项临床体征组成的综合评分达成一致，同时结合功能障碍评分。体征和症状将分别按 0-3 严重程度评分，并以序数变量表示总分；无/轻度/中度/重度 PTS。功能障碍部分评估体征和症状对患者手臂功能的影响。
就 UE-PTS 的体征和症状综合评分达成一致，同时结合功能障碍评分。需要在大量患者队列中对 UE-PTS 评分进行临床验证，以促进其在未来研究中的应用。
