Criado E, Burnham C B
Division of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, USA.
Surgery. 1997 Sep;122(3):578-83. doi: 10.1016/s0039-6060(97)90131-8.
The widespread use of ultrasonography for the diagnosis of deep vein thrombosis (DVT) has led to the overuse of ultrasonography with low diagnostic yield. We conducted this study to investigate the predictive value of clinical features in the diagnosis of DVT and their potential value as clinical guidelines for the use of ultrasonographic testing in the diagnosis of DVT.
The results of lower-extremity duplex ultrasonographic studies and clinical surveys prospectively obtained in 1526 patients suspected of having DVT were analyzed.
There were 916 inpatients and 610 outpatients. Acute DVT was found in 16% of the inpatient duplex scans, and in 12% of the outpatient studies (p < 0.05). The incidence of acute DVT was not different between men and women in inpatient or outpatient populations. Acute DVT was found in the left leg in 60% of the outpatient studies, significantly more often (p < 0.001) than in the inpatients (35%). Bilateral DVT was more common (p < 0.05) in the inpatient population (35%) compared with the outpatient population (20%). No difference in the anatomic distribution of thrombosis was found between inpatients and outpatients. The presence of leg symptoms was associated with a significantly higher rate (p < 0.05) of positive studies compared with those patients without leg symptoms in both the inpatient and the outpatient populations. Individual symptoms, risk factors, and physical findings had low positive predictive value and sensitivity for the presence of acute DVT on duplex scan. A calf circumference discrepancy of less than 2 cm predicted the absence of DVT in 93% of inpatients and 85% of outpatients. The combination of a calf circumference discrepancy of less than 2 cm with the absence of recent operation, trauma, malignancy, previous history of DVT, or hypercoagulable state predicted the absence of DVT in 92% of the inpatients and 97% of the outpatients.
Clinical symptoms, risk factors, and physical findings are poor predictors of the presence of acute DVT on duplex scan. However, the absence of a combination of objective clinical factors has high predictive value for the absence of acute DVT on duplex scan. These criteria may be used to establish clinical guidelines to reduce the use of duplex scanning for the diagnosis of DVT.
超声检查在深静脉血栓形成（DVT）诊断中的广泛应用导致了其过度使用且诊断率较低。我们开展本研究以调查临床特征在DVT诊断中的预测价值及其作为DVT诊断中超声检查临床指南的潜在价值。
对前瞻性获取的1526例疑似DVT患者的下肢双功超声检查结果和临床调查结果进行分析。
有916例住院患者和610例门诊患者。住院患者双功扫描中急性DVT的检出率为16%，门诊患者中为12%（p<0.05）。住院或门诊人群中，急性DVT的发病率在男性和女性之间无差异。门诊研究中60%的急性DVT发生在左腿，显著高于住院患者（35%）（p<0.001）。住院患者中双侧DVT更常见（p<0.05）（35%），而门诊患者中为20%。住院患者和门诊患者在血栓形成的解剖分布上无差异。与无腿部症状的患者相比，住院和门诊患者中存在腿部症状与检查阳性率显著更高（p<0.05）相关。个体症状、危险因素和体格检查结果对双功扫描显示急性DVT的阳性预测值和敏感性较低。小腿周径差异小于2cm可预测93%的住院患者和85%的门诊患者不存在DVT。小腿周径差异小于2cm且近期无手术、创伤、恶性肿瘤、既往DVT病史或高凝状态，可预测92%的住院患者和97%的门诊患者不存在DVT。
临床症状、危险因素和体格检查结果对双功扫描显示急性DVT的预测能力较差。然而，缺乏客观临床因素的组合对双功扫描显示不存在急性DVT具有较高的预测价值。这些标准可用于制定临床指南，以减少用于DVT诊断的双功扫描的使用。
