title: Validation of the LEFt score, a newly proposed diagnostic tool for deep vein thrombosis in pregnant women.
abstract: BACKGROUND
  The diagnosis of deep vein thrombosis (DVT) in pregnant women remains a challenge for physicians. The 'LEFt' clinical decision rule was recently derived, that might help in estimating the pretest probability of DVT during pregnancy. Our aim was to externally validate the LEFt clinical decision rule among pregnant women included in the OPTIMEV study.
  
  
  METHODS
  The OPTIMEV study is a diagnostic and epidemiologic study that included patients with suspected VTE between November 2004 and January 2006. All patients underwent standardized clinical data collection, and a bilateral whole-leg venous ultrasonography. A 3-month follow-up was performed in all patients with confirmed VTE, and in a randomly selected subsample of patients with negative diagnostic workup.
  
  
  RESULTS
  Of the 8,256 included patients, 96 were pregnant women. A DVT was diagnosed at CUS in 9 women (9.4%). The LEFtscore was computed in all but 7 women with missing values: one point in case of left ('L') leg suspicion, one point for edema ('E') and one point if the suspicion occurred during the first trimester ('Ft') of pregnancy. Prevalence of confirmed DVT was as follows: 1/30 (3%) in women with no LEFt criteria, 3/35 (9%), 2/20 (10%), and 3/4 (75%) in women with 1, 2 and 3 points, respectively.
  
  
  CONCLUSIONS
  Our results confirm the ability of the LEFt rule to estimate the pretest probability of DVT. Future studies are required to prospectively validate these findings and to define the role of the rule in a diagnostic algorithm for DVT during pregnancy.
authors.affiliation: Department of Internal Medicine and Chest Diseases, Brest University Hospital, Brest, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Le Moigne
authors.affiliation: UJF Grenoble 1, CNRS, Center for Clinical Investigation, Department of Public Health, Grenoble University Hospital, Themas, Grenoble, France.
authors.forename: Celine
authors.initials: C
authors.lastname: Genty
authors.affiliation: Le Relecq-Kerhuon, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Meunier
authors.affiliation: Division of Vascular Medicine, Grenoble University Hospital, Grenoble, France.
authors.forename: Anne-Cecile
authors.initials: AC
authors.lastname: Arnoult
authors.affiliation: Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Righini
authors.affiliation: EA3878, Université de Brest, Brest, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Bressollette
authors.affiliation: UJF Grenoble 1, CNRS, Center for Clinical Investigation, Department of Public Health, Grenoble University Hospital, Themas, Grenoble, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Bosson
authors.affiliation: Centre d'Investigation Clinique 0503, Université de Brest, Brest, France; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada. Electronic address: glegal@ohri.ca.
authors.forename: Gregoire
authors.initials: G
authors.lastname: Le Gal
mesh_terms: D000328:Adult; D003661:Decision Support Techniques; D004487:Edema / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011261:Pregnancy Trimester, First; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology
keywords: Deep vein thrombosis; Diagnosis; Pregnancy; Ultrasonography