用于评估门诊急诊科患者深静脉血栓形成概率的简单临床评分系统的开发与内部验证
Development and internal validation of a simple clinical score for the estimation of the probability of deep vein thrombosis in outpatient emergency department patients.
作者信息
Halstensen Thor-David, Hardeland Camilla, Ghanima Waleed, Grøndahl Vigdis Abrahamsen, Hubin Aliaksandr, Tavoly Mazdak
机构信息
Faculty of Health, Welfare and Organisation, Østfold University College, Fredrikstad, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
出版信息
Res Pract Thromb Haemost. 2024 Oct 29;8(8):102608. doi: 10.1016/j.rpth.2024.102608. eCollection 2024 Nov.
BACKGROUND
Wells score comprises subjective elements, making physicians reluctant to use Wells score or cause them to use it incorrectly.
OBJECTIVES
To develop and internally validate a prediction score that is objective and simple for evaluating suspected deep vein thrombosis (DVT), with a safety comparable with that of Wells score.
METHODS
We performed a post hoc analysis using data from the Ri-Schedule study (NCT02486445) involving suspected DVT patients at Østfold Hospital's Emergency Department, Norway (2015-2018). Candidate variables were identified through bootstrapping technique, with a confirmed DVT diagnosis as the outcome variable. Sensitivity, specificity, negative predictive value (NPV), and positive predictive values (PPV) were estimated and compared with the 2-tier Wells score.
RESULTS
Among 1312 patients (median age, 64 years [IQR, 52-73]; 55% women), 19.9% were diagnosed with DVT. Exploration of 30 variables identified tenderness along deep veins and previous venous thromboembolism as significant predictors (selection frequency >60% in 1000 bootstrapping samples). The derived score categorized 450 patients with 0 items as unlikely to have DVT, of whom 8.0% were diagnosed with DVT, compared with 8.2% in DVT unlikely category according to Wells score. Compared with Wells score, the derived score demonstrated sensitivity of 86.2 (95% CI, 81.4-90.2) vs 80.1 (95% CI, 74.7-84.8), specificity of 39.4 (95% CI, 36.4-42.4) vs 55.3 (95% CI, 52.2-58.3), NPV of 92.0 (95% CI, 89.4-94.0) vs 91.8 (95% CI, 89.7-93.5), and PPV of 26.1 (95% CI, 24.8-27.5) vs 30.8 (95% CI, 28.9-32.8). When incorporating D-dimer cutoff of <0.5 µg/mL, the derived score had sensitivity of 99.6 (95% CI, 97.9-99.9), specificity of 16.1 (95% CI, 13.1-18.4), NPV of 99.4 (95% CI, 96.0-99.9), and PPV of 22.8 (95% CI, 22.3-23.3).
CONCLUSION
The derived DVT score, with 2 objective variables, had a comparable safety with that of the Wells score. However, an external validation is mandated prior to clinical use.
背景
Wells评分包含主观因素，这使得医生不愿使用Wells评分或导致他们错误使用。
目的
开发并进行内部验证一个客观且简单的预测评分，用于评估疑似深静脉血栓形成（DVT），其安全性与Wells评分相当。
方法
我们使用来自Ri-Schedule研究（NCT02486445）的数据进行事后分析，该研究涉及挪威东福尔郡医院急诊科的疑似DVT患者（2015 - 2018年）。通过自抽样技术确定候选变量，以确诊的DVT诊断作为结果变量。估计敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV），并与两级Wells评分进行比较。
结果
在1312例患者中（中位年龄64岁[四分位间距，52 - 73岁]；55%为女性），19.9%被诊断为DVT。对30个变量的探索确定沿深静脉压痛和既往静脉血栓栓塞为显著预测因素（在1000次自抽样样本中的选择频率>60%）。得出的评分将450例0项的患者归类为不太可能患有DVT，其中8.0%被诊断为DVT，而根据Wells评分在DVT不太可能类别中的比例为8.2%。与Wells评分相比，得出的评分显示敏感性为86.2（95%CI，81.4 - 90.2）对80.1（95%CI，74.7 - 84.8），特异性为39.4（95%CI，36.4 - 42.4）对55.3（95%CI，52.2 - 58.3），NPV为92.0（95%CI，89.4 - 94.0）对91.8（95%CI，89.7 - 93.5），PPV为26.1（95%CI，24.8 - 27.5）对30.8（95%CI，28.9 - 32.8）。当纳入D - 二聚体临界值<0.5μg/mL时，得出的评分敏感性为99.6（95%CI，97.9 - 99.9），特异性为16.1（95%CI，13.1 - 18.4），NPV为99.4（95%CI，96.0 - 99.9），PPV为22.8（95%CI，22.3 - 23.3）。
结论
得出的DVT评分有2个客观变量，其安全性与Wells评分相当。然而，在临床使用前必须进行外部验证。
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