Critical appraisal of the diagnostics of 270 consecutive cases of suspected venous thromboembolism and established consequences at a non-university center.
OBJECTIVE
Diagnostic strategies in venous thromboembolism (VTE) are subject to controversy and rapid change and are dependent on the availability of the specific tests. The aim was to critically analyse the diagnostic procedures in patients with VTE at an intermediate size, non-university hospital.


METHODS
The diagnostic work up of 270 consecutive patients with suspected VTE disorders was analysed prospectively and the therapeutic decisions were monitored and compared with the actually implemented new standard evaluation which consists of a sequential application of the diagnostic tools (clinical probability, D-dimer compression ultrasound V/Q lung scan or CT). The patients were followed clinically for at least three months.


RESULTS
50% of the 55 patients with suspected deep vein thrombosis (DVT) and 35% of the 215 patients with suspected pulmonary embolism (PE) were found positive and were anticoagulated. The overall number of patients being anticoagulated was not significantly changed by the new procedure but approximately 30% of the additional examinations inclusive V/Q-scans, spiral CT and compression ultrasound or phlebography could be saved. Our study and the follow up after the therapeutic decision indicate that 92% of the patients can be clearly and safely allocated, while the remainders are managed according to an essentially clinical decision.


CONCLUSIONS
The vast majority (>90%) of the patients can be clearly diagnosed as positive or negative with the strategy presently used. A minority still requires an "overall decision". Our modified approach results in considerable cost savings.
Lukaschek
J
J
Chefarzt Dept. Innere Medizin, Kantonsspital, Baden, CH-5404, Switzerland.
Schmid
H R
HR
Vorburger
C
C
Beer
J H
JH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D003952:Diagnostic Imaging / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000453:epidemiology; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D013557:Switzerland / Q000453:epidemiology; D013923:Thromboembolism / Q000175:diagnosis* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014463:Ultrasonography / Q000379:methods / Q000706:statistics & numerical data; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy
D000925:Anticoagulants