Rosen M P, Sheiman R G, Weintraub J, McArdle C
Department of Radiology, Beth Israel Hospital, Boston, MA 02215, USA.
AJR Am J Roentgenol. 1996 Feb;166(2):285-9. doi: 10.2214/ajr.166.2.8553931.
We sought to determine whether compression sonography could be eliminated in the evaluation of patients who lacked both thromboembolic risk factors and symptoms of deep-vein thrombosis and who had an indeterminate or low-probability lung scan.
The medical records of 155 consecutive patients who underwent bilateral lower-extremity sonography after an indeterminate or low-probability lung scan were reviewed. The presence of thromboembolic risk factors and deep-vein thrombosis symptoms and the result of sonography were recorded. Patients were divided into two groups: group 1 consisted of patients with either thromboembolic risk factors or deep-vein thrombosis symptoms, and group 2 consisted of patients without thromboembolic risk factors and without deep-vein thrombosis symptoms. The incidences of deep-vein thrombosis in groups 1 and 2 were compared by use of a two-tailed Fisher's exact test.
Thromboembolic risk factors or deep-vein thrombosis symptoms were found in 109 of 155 patients (70%) (group 1). Deep-vein thrombosis was found in nine of 108 patients (8%) in group 1. Both thromboembolic risk factors and deep-vein thrombosis symptoms were absent in 47 of 155 patients (30%) (group 2). Deep-vein thrombosis was found in none of 47 patients (95% confidence interval, 0-8%) in group 2. The difference in the incidences of deep-vein thrombosis in groups 1 and 2 approached statistical significance (p = .0579). The negative predictive value of the absence of both thromboembolic risk factors and deep-vein thrombosis symptoms in excluding deep-vein thrombosis was 100% (95% confidence interval, 93-100%).
If both symptoms of deep-vein thrombosis and thromboembolic risk factors are absent, the usefulness of lower-extremity sonography in detecting deep-vein thrombosis in patients with an indeterminate or low-probability lung scan is low. The manner in which these findings may be used to modify individual practice patterns will undoubtedly depend on the rate of detection of deep-vein thrombosis at a given institution.
我们试图确定对于既无血栓栓塞危险因素又无深静脉血栓形成症状且肺部扫描结果不确定或可能性较低的患者，在评估时是否可以不进行加压超声检查。
回顾了155例肺部扫描结果不确定或可能性较低后接受双侧下肢超声检查的连续患者的病历。记录血栓栓塞危险因素、深静脉血栓形成症状的存在情况以及超声检查结果。患者分为两组：第1组包括有血栓栓塞危险因素或深静脉血栓形成症状的患者，第2组包括既无血栓栓塞危险因素又无深静脉血栓形成症状的患者。采用双侧Fisher精确检验比较第1组和第2组深静脉血栓形成的发生率。
155例患者中有109例（70%）（第1组）存在血栓栓塞危险因素或深静脉血栓形成症状。第1组108例患者中有9例（8%）发现深静脉血栓形成。155例患者中有47例（30%）（第2组）既无血栓栓塞危险因素也无深静脉血栓形成症状。第2组47例患者中无一例发现深静脉血栓形成（95%置信区间，0 - 8%）。第1组和第2组深静脉血栓形成发生率的差异接近统计学显著性（p = 0.0579）。既无血栓栓塞危险因素又无深静脉血栓形成症状在排除深静脉血栓形成方面的阴性预测值为100%（95%置信区间，93 - 100%）。
如果既无深静脉血栓形成症状又无血栓栓塞危险因素，对于肺部扫描结果不确定或可能性较低的患者，下肢超声检查在检测深静脉血栓形成方面的效用较低。这些发现可用于改变个体实践模式的方式无疑将取决于特定机构深静脉血栓形成的检出率。
