[Diagnostic strategy in patients with clinically suspected deep vein thrombosis].
BACKGROUND
The standard method for diagnosing deep vein thrombosis (DVT) involves determination of D-dimer and ultrasound scanning. In an attempt to reduce the number of ultrasound examinations we have supplemented this with a clinical probability estimate for DVT (DVT-score) over one year.


METHODS
A total of 508 consecutive patients presenting in the emergency room with suspected DVT had D-dimer and DVT-score performed. Patients with non-elevated D-dimer and a low or moderate DVT score received no treatment. The remainder had ultrasound scanning from the groin to the popliteal fossa. If no DVT was revealed, the patient was contacted by telephone 7-10 days later, and was offered a repeat examination if symptoms persisted.


RESULTS
Three patients with chronic DVT were excluded. Normal D-dimer and low or moderate DVT-score was found in 103 patients, none had DVT. Only five patients with normal D-dimer had high DVT-scores, none had DVT, so that the benefit from determining DVT-scores was modest. Ultrasound scanning revealed DVT in 85 out of 397 patients with elevated D-dimer. A repeat examination was performed in 91 patients with persisting symptoms, and disclosed DVT in two.


CONCLUSIONS
We recommend that ambulatory patients with clinically suspected DVT have a D-dimer test. If D-dimer is elevated, compression ultrasound should be performed in the groin and the popliteal fossa.
Mantoni
Margit Y
MY
Gentofte Hospital, Billeddiagnostisk Afdeling, DK-2900 Hellerup. mama@geh.regionh.dk
Kristensen
Majken
M
Brogaard
Marie Husted
MH
Sivertsen
Jacob Christian
JC
Nielsen
Jørn Dalsgaard
JD
Strandberg
Charlotte
C
Friis
Steffen
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006119:Groin / Q000000981:diagnostic imaging; D006801:Humans; D007717:Knee / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D