Anand S S, Wells P S, Hunt D, Brill-Edwards P, Cook D, Ginsberg J S
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
JAMA. 1998 Apr 8;279(14):1094-9. doi: 10.1001/jama.279.14.1094.
To review the validity of the clinical assessment and diagnostic tests in patients with suspected deep vein thrombosis (DVT).
A comprehensive review of the literature was conducted by searching MEDLINE from 1966 to April 1997.
Individual symptoms and signs alone do not reliably predict which patients have DVT. Overall, the diagnostic properties of the clinical examination are poor; the sensitivity of the clinical examination ranges from 60% to 96%, and the specificity ranges from 20% to 72%. However, using specific combinations of risk factors, symptoms, and physical signs for DVT, clinicians can reliably stratify patients with suspected DVT into low, moderate, or high pretest probability categories of actually suffering from DVT. This stratification process in combination with noninvasive testing, such as compression ultrasonography, simplifies the management strategies for patients with suspected DVT.
Use of a clinical prediction guide that includes specific factors from both the history and physical examination in combination with noninvasive tests simplifies management strategies for patients with suspected DVT.
评估对疑似深静脉血栓形成（DVT）患者进行临床评估及诊断检测的有效性。
通过检索1966年至1997年4月的MEDLINE数据库对文献进行全面综述。
仅凭个体症状和体征无法可靠地预测哪些患者患有DVT。总体而言，临床检查的诊断性能较差；临床检查的敏感性为60%至96%，特异性为20%至72%。然而，通过使用DVT的危险因素、症状和体征的特定组合，临床医生可以可靠地将疑似DVT患者分为实际患DVT的低、中、高预测试概率类别。这种分层过程与诸如压迫超声等非侵入性检测相结合，简化了疑似DVT患者的管理策略。
使用包含病史和体格检查中特定因素的临床预测指南，并结合非侵入性检测，可简化疑似DVT患者的管理策略。
