title: Predicting deep venous thrombosis in pregnancy: out in "LEFt" field?
abstract: BACKGROUND
  Clinicians' assessment of pretest probability, based on subjective criteria or prediction rules, is central to the diagnosis of deep venous thrombosis (DVT). Pretest probability assessment for DVT diagnosis has never been evaluated in pregnant women.
  
  
  OBJECTIVE
  To evaluate the accuracy of clinicians' subjective assessment of pretest probability for DVT diagnosis and identify prediction variables that could be used for pretest probability assessment in pregnant women with suspected DVT.
  
  
  METHODS
  A cross-sectional study conducted over 7 years (March 2000 to April 2007).
  
  
  METHODS
  5 university-affiliated, tertiary care centers in Canada.
  
  
  METHODS
  194 unselected pregnant women with suspected first DVT.
  
  
  METHODS
  Diagnosis of DVT was established with abnormal compression ultrasonography at presentation or on serial imaging. Pretest probability by subjective assessment was recorded by thrombosis experts for each patient before knowledge of results.
  
  
  METHODS
  The sensitivity, specificity, negative predictive value, and likelihood ratios of subjective pretest probability assessment and their corresponding 95% CIs were calculated on the basis of the diagnosis of DVT. Patients were DVT positive if they had diagnostic compression ultrasonography at initial or serial testing or symptomatic venous thromboembolism on follow-up. Patients were DVT negative if they had negative compression ultrasonography at presentation and no venous thromboembolism on follow-up. A prediction rule for assessing DVT was derived, and an internal validation study was done to explore its performance.
  
  
  RESULTS
  The prevalence of DVT was 8.8%. Clinicians' subjective assessment of pretest probability categorized patients into 2 groups: low pretest probability (two thirds of patients) with a low prevalence of DVT (1.5% [95% CI, 0.4% to 5.4%]) and a negative predictive value of 98.5% (CI, 94.6% to 99.6%), and nonlow pretest probability with a higher prevalence of DVT (24.6% [CI, 15.5% to 36.7%]). Three variables (symptoms in the left leg [L], calf circumference difference > or = 2 cm [E], and first trimester presentation [Ft]) were highly predictive of DVT in pregnant patients.
  
  
  CONCLUSIONS
  Few outcomes occurred. Altogether, 17 events were diagnosed during the study. The prediction rule derived should be validated on an independent sample before applying it to clinical practice.
  
  
  CONCLUSIONS
  Subjective assessment of pretest probability seems to exclude DVT when the pretest probability is low. Moreover, 3 objective variables ("LEFt") may improve the accuracy of the diagnosis of DVT in pregnancy. Prospective validation studies are needed.
  
  
  BACKGROUND
  Heart and Stroke Foundation of Ontario.
authors.affiliation: Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada. wee-shian.chan@wchospital.ca
authors.forename: Wee-Shian
authors.initials: WS
authors.lastname: Chan
authors.forename: Agnes
authors.initials: A
authors.lastname: Lee
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.forename: Mark
authors.initials: M
authors.lastname: Crowther
authors.forename: Marc
authors.initials: M
authors.lastname: Rodger
authors.forename: Tim
authors.initials: T
authors.lastname: Ramsay
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Ginsberg
mesh_terms: D003430:Cross-Sectional Studies; D004487:Edema / Q000473:pathology; D005260:Female; D006801:Humans; D007866:Leg / Q000473:pathology; D008487:Medical History Taking; D015999:Multivariate Analysis; D010808:Physical Examination; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011261:Pregnancy Trimester, First; D011336:Probability; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging