Validation of the new venous severity scoring system in varicose vein surgery
Validation of the new venous severity scoring system in varicose vein surgery
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DOI：
10.1016/s0741-5214(03)00323-9
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发表时间：
2003-08-01
影响因子：
4.3
通讯作者：
Geroulakos, G
中科院分区：
文献类型：
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作者：
Kakkos, SK;Rivera, MA;Geroulakos, G
目标.我们进行了这项观察性研究，以验证新的静脉严重程度评分（VSS）系统的三个组成部分，即静脉临床严重程度评分（VCSS），静脉节段性疾病评分（VSDS）和静脉功能障碍评分（VDS），并评估VCSS，VDS和CEAP临床分类和评分在量化静脉曲张手术的结果。该研究包括45名患者，他们在48条原发性静脉曲张的腿上接受了浅静脉手术。在术前、术后6周和6个月分别进行静脉彩色多普勒扫描、临床检查和问卷调查，对VSS和CEAP进行临床分级和评分。CEAP临床评分、VCSS和VDS与CEAP临床分级呈线性相关（分别为P <0.001、P <0.001、P = 0.002）。所有严重程度评分之间存在良好的相关性，特别是CEAP临床评分与VCSS之间（r = 0.94; P < .001）。CEAP临床评分与CEAP临床分级（r = 0.84; P <0.001）和VDS（r = 0.70; P <0.001）也高度相关。同样，VCSS与CEAP临床分级（r = 0.83; P <0.001）和VDS（r = 0.72; P <0.001）相关。解剖学严重度标志物VSDS与临床严重度指标VCSS（r = 0.29; P = 0.048）和VDS（r = 0.31; P = 0.03）弱相关，但与年龄、性别或CEAP临床分类和评分无关。术后6个月，VCSS（73%;范围，50%-100%）和CEAP临床评分（70%;范围，50%-100%）的中位（四分位距）百分比变化均显著大于（P <0.001）CEAP临床分类的相应变化（17%;范围，0%-50%）。在基线VDS高的下肢中，VDS的中位数（四分位距）百分比变化为100%（范围，50%-100%），显著大于（P <0.001）CEAP临床分类的相应变化（0%;范围，0%-17%）。静脉严重程度评分在晚期静脉疾病中显著更高，表明与解剖程度相关。静脉临床严重程度评分（VCSS和CEAP临床评分）在测量浅静脉手术反应变化方面的敏感性相同，且显著优于已使用的CEAP临床分类。VDS表现出相当甚至更好的性能。尽管CEAP临床分类的分配可能足以满足日常临床目的，但在临床研究中应使用静脉严重程度评分系统来量化静脉结局。
Objectives. We performed this observational study to validate the three components of a new venous severity scoring (VSS) system, ie, venous clinical severity score (VCSS), venous segmental disease score (VSDS), and venous disability score (VDS), and to evaluate VCSS, VDS, and CEAP clinical class and score in quantifying outcome of varicose vein surgery.Patients and Methods. The study included 45 patients who underwent superficial venous surgery in 48 legs with primary varicose veins. Venous color duplex scanning, clinical examination, and a questionnaire were used preoperatively and at 6 weeks and 6 months postoperatively to assign VSS and CEAP clinical class and score.Results. CEAP clinical score, VCSS, and VDS demonstrated a linear association with CEAP clinical class (P < .001, P < .001, P = .002, respectively). Good correlation among all severity scores was found, particularly between CEAP clinical score and VCSS (r = 0.94; P < .001). CEAP clinical score was also highly correlated with CEAP clinical class (r = 0.84; P < .001) and VDS (r = 0.70; P < .001). Similarly, VCSS correlated with CEAP clinical class (r = 0.83; P < .001) and also VDS (r = 0.72; P < .001). The anatomic severity marker VSDS demonstrated a weak correlation with clinical severity indicators VCSS (r = 0.29; P = .048) and VDS (r = 0.31; P = .03) but not with age, gender, or CEAP clinical class and score. Six months after surgery the median (interquartile range) percent change in VCSS (73%; range, 50%-100%) and CEAP clinical score (70%; range, 50%-100%) were both significantly greater (P < .001) than the corresponding change in CEAP clinical class (17%; range, 0%-50%). In legs with high VDS at baseline, median (interquartile range) percent change in VDS was 100% (range, 50%-100%), significantly greater (P < .001) than the corresponding change in CEAP clinical class (0%; range, 0%-17%).Conclusions. Venous severity scores are significantly higher in advanced venous disease, demonstrating correlation with anatomic extent. Both venous clinical severity scores, VCSS and CEAP clinical score, are equally sensitive and significantly better for measuring changes in response to superficial venous surgery than is the already in use CEAP clinical class. VDS demonstrated comparable and even better performance. Although the assignment of CEAP clinical class might be adequate for daily clinical purposes, venous severity scoring systems should be used in clinical studies to quantify venous outcome.