title: Incremental value of hormonal therapy for deep vein thrombosis prediction: an adjusted Wells score for women.
abstract: Deep venous thrombosis (DVT) management includes prediction rule evaluation to define standard pretest DVT probabilities in symptomatic patients. The aim of this study was to evaluate the incremental usefulness of hormonal therapy to the Wells prediction rules for DVT in women. We studied women undertaking compressive ultrasound scanning for suspected DVT. We adjusted the Wells score for DVT, taking into account the β-coefficients of the logistic regression model. Data discrimination was evaluated by the receiver operating characteristic (ROC) curve. The adjusted score calibration was assessed graphically and by the Hosmer-Lemeshow test. Reclassification tables and the net reclassification index were used for the adjusted score comparison with the Wells score for DVT. We observed 461 women including 103 DVT events. The mean age was 56 years (±21 years). The adjusted logistic regression model included hormonal therapy and six Wells prediction rules for DVT. The adjusted score weights ranged from -4 to 4. Hosmer-Lemeshow test showed a nonsignificant P value (0.69) and the calibration graph showed no differences between the expected and the observed values. The area under the ROC curve was 0.92 [95% confidence interval (CI) 0.90-0.95] for the adjusted model and 0.87 (95% CI 0.84-0.91) for the Wells score for DVT (Delong test, P value < 0.01). Net reclassification index for the adjusted score was 0.22 (95% CI 0.11-0.33, P value < 0.01). Our results suggest an incremental usefulness of hormonal therapy as an independent DVT prediction rule in women compared with the Wells score for DVT. The adjusted score must be evaluated in different populations before clinical use.
authors.affiliation: aEscola de Medicina, Faculdade de Saúde e Ecologia Humana, Vespasiano bDepartamento de Imagem Diagnóstica e Terapêutica, Hospital Mater Dei, Belo Horizonte cGrupo de Estudos de Medicina Tropical, Pós-Graduação em Ciências da Saúde da Faculdade de Medicina, da Universidade Federal de Minas Gerais, Minas Gerais, Brazil.
authors.forename: Márcio Vinícius Lins de
authors.initials: MV
authors.lastname: Barros
authors.forename: Ana Elisa Loyola
authors.initials: AE
authors.lastname: Arancibia
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Costa
authors.forename: Fernando Brito
authors.initials: FB
authors.lastname: Bueno
authors.forename: Marcela Aparecida Corrêa
authors.initials: MA
authors.lastname: Martins
authors.forename: Maria Cláudia
authors.initials: MC
authors.lastname: Magalhães
authors.forename: José Luiz Padilha
authors.initials: JL
authors.lastname: Silva
authors.forename: Marcos de
authors.initials: Md
authors.lastname: Bastos
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006728:Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D020246:Venous Thrombosis / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D006728:Hormones; C036309:fibrin fragment D