Use of a simplified clinical scoring system and D-dimer testing can reduce the requirement for radiology in the exclusion of deep vein thrombosis by over 20%.
A simplified, robust, clinical assessment, used in conjunction with a D-dimer assay, has been developed to identify patients with a low risk of deep vein thrombosis. These patients did not undergo radiological examination. The protocol has been used by junior doctors in a district general hospital with a predominantly elderly population. Four hundred and thirty-one patients with potential deep vein thrombosis of the lower limb were assessed using this method and 98 (22.7%) did not require further investigation. Of these, one was admitted 5 months later with a pulmonary embolus. None of the other patients subsequently required admission for a thromboembolic event or died during a minimum of 3 months follow-up.
Janes
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S
Department of Haematology, St Richard's Hospital, Chichester PO19 4SE, UK. Sarah.Janes@rws-tr.sthames.nhs.uk
Ashford
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N
D000368:Aged; D000933:Antifibrinolytic Agents / Q000032:analysis*; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg; D010808:Physical Examination; D011859:Radiography; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging
D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; D011933:Reagent Kits, Diagnostic; C036309:fibrin fragment D