Comparison of four clinical prediction scores for the diagnosis of lower limb deep venous thrombosis in outpatients.
OBJECTIVE
We compared three scores for the prediction of deep venous thrombosis with a new score designed specifically for outpatients.


METHODS
Patients referred for evaluation because of suspected deep venous thrombosis were examined by ultrasonography. Sensitivity and specificity were calculated for three clinical scores (Wells [nine components], Kahn [four components], and St. André [six components]). We developed a new score by multivariate analysis, and then compared this score with the others in a new sample.


RESULTS
Four hundred and forty-four outpatients were included in the first sample, of whom 126 (28%) had deep venous thrombosis. The Wells score was a better predictor of deep venous thrombosis than the Kahn and St. André scores. According to the Wells score, 73 patients had a high probability of deep venous thrombosis (of whom 51 [70%] actually had a thrombosis) and 178 had a low probability of deep venous thrombosis (of whom 19 [11%] had a thrombosis). A new score was developed as follows: male sex (+1), lower limb palsy or immobilization (+1), confinement to bed >3 days (+1), lower limb enlargement (+1), unilateral lower limb pain (+1), and other plausible diagnosis (-1). In a validation sample of 282 outpatients, this score identified 31 patients who had a high probability of deep venous thrombosis (score > or =3), of whom 18 (58%) had a thrombosis, and 70 patients who had a low probability (score < or =0), of whom 3 (4%) had a thrombosis. The Wells score and this ambulatory score had similar test operating characteristics in the validation sample.


CONCLUSIONS
Our new six-component score had similar diagnostic utility as the nine-component Wells score among outpatients being evaluated for deep venous thrombosis.
Constans
Joël
J
Service de Médecine Interne et Pathologie Vasculaire, Hôpital Saint-André, Bordeaux, France. joel.constans@chu-bordeaux.fr
Boutinet
Catherine
C
Salmi
L Rachid
LR
Saby
Jean-Claude
JC
Nelzy
Marie-Line
ML
Baudouin
Patrice
P
Sampoux
Françoise
F
Marchand
Jean-Marie
JM
Boutami
Caroline
C
Dehant
Véronique
V
Pulci
Stéphane
S
Gauthier
Jean Paul
JP
Cacareigt-Bourdenx
Véronique
V
Barcat
Damien
D
Conri
Claude
C
D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000175:diagnosis / Q000000981:diagnostic imaging*