The wells rule does not adequately rule out deep venous thrombosis in primary care patients
The wells rule does not adequately rule out deep venous thrombosis in primary care patients
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DOI：
10.7326/0003-4819-143-2-200507190-00008
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发表时间：
2005-07-19
影响因子：
39.2
通讯作者：
Moons, KGM
中科院分区：
文献类型：
--
作者：
Oudega, R;Hoes, AW;Moons, KGM
背景：利用二级保健门诊患者的数据，Wells 和同事制定了一种诊断规则来估计深静脉血栓 (DVT) 存在的可能性。 Wells 规则的准确性尚未在疑似 DVT 的初级保健患者中得到正确验证。目的：在初级保健环境中验证 Wells 规则的诊断准确性，无论是否进行 D-二聚体检测。设计：2002 年 1 月 1 日至 2003 年 3 月 1 日收集前瞻性数据的横断面研究。背景：荷兰特定地理区域的 110 个初级保健诊所。参与者：1295 名连续患者向他们的初级保健医生咨询提示 DVT 的症状。测量：所有患者均接受病史采集和体格检查，以计算 Wells 规则评分和 D-二聚体测试。重复腿部超声检查是确定是否真实存在 DVT 的参考标准。结果：在初级保健机构中，低危组中 12.0% 的患者患有 DVT； Wells 及其同事的最初研究报告称，此类患者的患病率为 3%。当与 D-二聚体检测的阴性结果相结合时，Wells 规则得出最低风险组中 DVT 的患病率为 2.9%，而原始研究中的患病率为 0.9%。 局限性：纳入了既往 DVT 的患者，且诊断参考标准与 Wells 及其同事的原始研究中使用的不同。结论： Wells 规则单独或与 D-二聚体检测结合使用，并不能保证对 DVT 发生的初级保健患者的风险进行准确估计。怀疑。
Background: using data from secondary care outpatients, Wells and colleagues developed a diagnostic rule to estimate the probability of the presence of deep venous thrombosis (DVT). The accuracy of the Wells rule has not been properly validated for use in primary care patients in whom DVT is suspected.Objective: To validate the diagnostic accuracy of the Wells rule, with and without D-dimer testing, in a primary care setting.Design: Cross-sectional study with prospective data collection from 1 January 2002 to 1 March 2003. Setting: 110 primary care practices in a circumscribed geographic region in The Netherlands.Participants: 1295 consecutive patients who consulted their primary care physician about symptoms suggestive of DVT.Measurements: All patients underwent history-taking and physical examination to calculate the Wells rule score, and D-dimer testing. Repeated leg ultrasonography was the reference standard to determine the true presence or absence of DVT.Results: In the primary care setting, 12.0% of patients in the low-risk group had DVT; the original study by Wells and colleagues reported a rate of 3% among such patients. When combined with negative results on a D-dimer test, the Wells rule yielded a prevalence of DVT of 2.9% in the lowest-risk group, whereas the prevalence was 0.9% in the original study.Limitations: Patients with previous DVT were included, and the diagnostic reference standard was different from that used in Wells and colleagues' original study.Conclusion: The Wells rule, alone or in combination with D-dimer testing, does not guarantee accurate estimation of risk in primary care patients in whom DVT is suspected.