[Can the frequency of color-coded duplex sonography in urgent examination of deep vein thrombosis be reduced by application of a clinical probability assessment?].
OBJECTIVE
Application and verification of the Wells score for pre-test probability of deep vein thrombosis in the lower limbs in clinical routine. The goal was to reduce the number of immediate diagnostic measures for excluding vein thrombosis during acute investigation. New parameters for upgrading or modification the existing score were checked.


METHODS
In a period from March through November 2007, 333 patients were assigned to the department of radiology in order to exclude deep vein thrombosis. A standardized questionnaire was used to identify the probability of deep vein thrombosis. The patients were categorized as low, moderate, and high risk. The examination was conducted with colored-coded duplex sonography.


RESULTS
In the patient population of 333, 41 (12 %) had deep vein thrombosis of the lower limb. The prevalence was approximately 3 % in the low risk group, 34 % in the moderate risk group, and 63 % in the high risk group. Categorization with the Wells score is an instrument with high sensitivity (99.6 %) and specificity (100 %).


CONCLUSIONS
The pre-test probability with the Wells score represents a useful and established instrument in the clinical routine. Acute examinations, especially during stand-by, can be reduced without neglecting patient safety. Patients with a Wells score of 0 don't require an acute examination. An elective investigation should be targeted. Patients with a score between 1 and 8 needed to be treated (within the next 24 hours) with KS and FKDS. According to on our data records, therapy should be started immediately for patients with a high risk of deep vein thrombosis.
Kamusella
P
P
Radiologie, Carl Gustav Carus Universitätsklinikum Dresden, Dresden, Germany. paipman@web.de
Wissgott
C
C
Boyé
A
A
Müller
S
S
Richter
A
A
Schink
T
T
Klein-Weigel
P
P
Steinkamp
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color / Q000706:statistics & numerical data*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging*; D055815:Young Adult