Accuracy of diagnostic tests for clinically suspected upper extremity deep vein thrombosis: a systematic review.
BACKGROUND
The best available test for the diagnosis of upper extremity deep venous thrombosis (UEDVT) is contrast venography. The aim of this systematic review was to assess whether the diagnostic accuracy of other tests for clinically suspected UEDVT is high enough to justify their use in clinical practise and to evaluate if any test can replace venography.


METHODS
MEDLINE and EMBASE databases were searched from inception to June 2009. Two reviewers independently evaluated study eligibility, extracted data, and assessed study quality.


RESULTS
We identified 17 papers, reporting on 793 patients. Overall, the methodological quality was poor, sample sizes were small, and large between-study differences were observed in spectrum and design. The summary estimates of sensitivity (95% confidence interval) were 97% (90-100%) for compression ultrasonography, 84% (72-97%) for Doppler ultrasonography, 91% (85-97%) for Doppler ultrasonography with compression, and 85% (72-99%) for phleboreography. The corresponding summary estimates of specificity were, respectively, 96% (87-100%), 94% (86-100%), 93% (80-100%), and 87% (71-100%). Clinical findings, a clinical score, D-dimer, magnetic resonance imaging, rheography and plethysmography were evaluated in one study each, involving a median number of 46 patients (range 21-214). Sensitivity and specificity ranged from 0% to 100% and from 14% to 100%.


CONCLUSIONS
Methodological limitations, large between-study differences and small sample sizes limit the evidence of tests for clinically suspected UEDVT. Compression ultrasonography may be an acceptable alternative to venography. The addition of (color) Doppler does not seem to improve the accuracy. Adequately designed studies are warranted to confirm these findings.
Di Nisio
M
M
Department of Medicine and Aging, Centre for Aging Sciences (Ce.S.I.), University G.D'Annunzio Foundation, Chieti, Italy. mdinisio@unich.it
Van Sluis
G L
GL
Bossuyt
P M M
PM
Büller
H R
HR
Porreca
E
E
Rutjes
A W S
AW
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002648:Child; D003287:Contrast Media; D003955:Diagnostic Tests, Routine; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D018056:Hemorheology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010690:Phlebography; D010991:Plethysmography; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler; D034941:Upper Extremity / Q000098:blood supply*; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D055815:Young Adult
D015415:Biomarkers; D003287:Contrast Media; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D