Venous severity scoring: An adjunct to venous outcome assessment
Venous severity scoring: An adjunct to venous outcome assessment
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DOI：
10.1016/s0741-5214(00)90143-5
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发表时间：
2000-06-01
影响因子：
4.3
通讯作者：
Moneta, GL
中科院分区：
文献类型：
--
作者：
Rutherford, RB;Padberg, FT;Moneta, GL
需要对疾病的严重程度进行一些测量，以适当地比较慢性静脉功能不全治疗的各种方法的结果。在临床试验中比较两种或两种以上不同治疗的结局，或者在文献中比较两种或两种以上报告中相同治疗的结局，除非每个治疗组中静脉疾病的相对严重程度是已知的，否则无法有把握地进行比较。CEAP（临床-病因学-解剖学-病理生理学）系统是一个很好的分类方案，但它不能用于静脉严重程度评分，因为它的许多组成部分是相对静态的，其他组成部分使用详细的字母名称。疾病严重程度评分方案需要是可量化的，其中可分级的元素可以根据治疗而改变。然而，美国静脉论坛静脉结局评估委员会已经基于CEAP系统的最佳可用元素开发了静脉严重程度评分系统。提出了两个分数。第一个是静脉临床严重程度评分：慢性静脉疾病的9个临床特征从0到3（无、轻度、中度、重度）分级，并采用特定标准以避免重叠或任意评分。对于背景保守治疗（压迫和抬高）的差异，增加0至3分，以产生最大30分的平面量表。第二种是静脉节段性疾病评分，它结合了CEAP的解剖学和病理生理学组成部分。主要静脉节段根据反流和/或阻塞的存在进行分级。红外成像完全基于静脉成像，主要是双功扫描，但也有静脉造影结果。该评分方案根据涉及反流和/或阻塞时的相对重要性对11个静脉节段进行加权，最高评分为10分。第三个评分只是对现有CEAP残疾评分的修改，该评分消除了对工作和8小时工作日的提及，取而代之的是患者先前的正常活动。这些新的评分计划旨在补充现行的CEAP系统。
Some measure of disease severity is needed to properly compare the outcomes of the various approaches to the treatment of chronic venous insufficiency. Comparing the outcomes of two or more different treatments in a clinical trial, or the same treatment in two or more reports from the literature cannot be done with confidence unless the relative severity of the venous disease in each treatment group is known. The CEAP (Clinical-Etiology-Anatomic-Pathophysiologic) system is an excellent classification scheme, but it cannot serve the purpose of venous severity scoring because many of its components are relatively static and others use detailed alphabetical designations. A disease severity scoring scheme needs to be quantifiable, with gradable elements that can change in response to treatment. However, an American Venous Forum committee on venous outcomes assessment has developed a venous severity scoring system based on the best usable elements of the CEAP system. Two scores are proposed. The first is a Venous Clinical Severity Score: nine clinical characteristics of chronic venous disease are graded from 0 to 3 (absent, mild, moderate, severe) with specific criteria to avoid overlap or arbitrary scoring. Zero to three points are added for differences in background conservative therapy (compression and elevation) to produce a 30 point-maximum flat scale. The second is a Venous Segmental Disease Score, which combines the Anatomic and Pathophysiologic components of CEAP. Major venous segments are graded according to presence of reflux and/or obstruction. Ir is entirely based on venous imaging, primarily duplex scan but also phlebographic findings. This scoring scheme weights 11 venous segments for their relative importance when involved with reflux and/or obstruction, with a maximum score of 10. A third score is simply a modification of the existing CEAP disability score that eliminates reference to work and an 8-hour working day, substituting instead the patient's prior normal activities. These new scoring schemes are intended to complement the current CEAP system.