title: Limited diagnostic value of Wells-score and D-dimer testing in hospitalized dermatologic patients with symptoms of deep vein thrombosis.
abstract: BACKGROUND
  D-dimer analysis and clinical probability scoring (Wells-score) show a high sensitivity and negative predictive value for the exclusion of deep vein thrombosis (DVT).
  
  
  OBJECTIVE
  To identify the diagnostic performance of D-dimer testing and Wells-score in hospitalized patients with dermatologic conditions.
  
  
  METHODS
  In this retrospective cohort study, 109 examinations in 102 patients were performed by Wells-score, Tina-quant D-dimer testing and whole-leg duplex ultrasonography or phlebography.
  
  
  RESULTS
  DVT was confirmed in 14 patients. The Wells-score alone allowed no discrimination of DVT and non-DVT patients. D-dimer testing identified all cases of DVT (100% sensitivity). Only 16 patients showed D-dimers within normal limits and none was diagnosed with DVT (100% negative predictive value). A high rate of false-positive D-dimer results (72%) led to a low specificity (17%). The number needed-to-test to exclude one DVT was 6.8. Based on multivariate statistical analysis, increased D-dimer levels were significantly associated with the dermatologic main diagnosis (p = 0.008), age (p = 0.001) and with the presence of DVT (p = 0.011). The highest D-dimer values were found in non-DVT patients with metastasized or systemic malignancies (median 2.48 mg/L) or inflammatory skin conditions (e.g., generalized psoriasis, median 2.22 mg/L).
  
  
  CONCLUSIONS
  Wells-score and D-Dimer testing were of limited diagnostic value because of many false-positive results. Required imaging procedures were reduced by only 16 cases (15%). Therefore, we suggest directly investigating hospitalized dermatologic patients with suspected DVT and skin diseases associated with high D-Dimer levels, by whole-leg compression ultrasonography.
authors.affiliation: Department of Dermatology, Venereology and Allergology.
authors.forename: Holger A
authors.initials: HA
authors.lastname: Haenssle
authors.affiliation: Department of Dermatology, Venereology and Allergology.
authors.forename: Nadia
authors.initials: N
authors.lastname: Ayad
authors.affiliation: Department of Dermatology, Venereology and Allergology.
authors.forename: Timo
authors.initials: T
authors.lastname: Buhl
authors.affiliation: Department of Genetic Epidemiology, Georg August University Göttingen, University Medical Center, Robert Koch Strasse 40, D 37075 Göttingen, Germany.
authors.forename: Albert
authors.initials: A
authors.lastname: Rosenberger
authors.affiliation: Department of Dermatology, Venereology and Allergology.
authors.forename: Kai Martin
authors.initials: KM
authors.lastname: Thoms
authors.affiliation: Department of Dermatology, Venereology and Allergology.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Schön
authors.affiliation: Department of Dermatology, Venereology and Allergology.
authors.forename: Markus
authors.initials: M
authors.lastname: Zutt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005189:False Positive Reactions; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012871:Skin Diseases / Q000097:blood* / Q000150:complications; D020246:Venous Thrombosis / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: D-dimer; Wells-score; deep vein thrombosis; skin diseases; whole-leg compression ultrasonography