title: A systematic review of clinical prediction scores for deep vein thrombosis.
abstract: Objective Diagnosis of deep vein thrombosis remains a challenging problem. Various clinical prediction rules have been developed in order to improve diagnosis and decision making in relation to deep vein thrombosis. The purpose of this review is to summarise the available clinical scores and describe their applicability and limitations. Methods A systematic search of PubMed, MEDLINE and EMBASE databases was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance using the keywords: clinical score, clinical prediction rule, risk assessment, clinical probability, pretest probability, diagnostic score and medical Subject Heading terms: 'Venous Thromboembolism/diagnosis' OR 'Venous Thrombosis/diagnosis'. Both development and validation studies were eligible for inclusion. Results The search strategy returned a total of 2036 articles, of which 102 articles met a priori criteria for inclusion. Eight different diagnostic scores were identified. The development of these scores differs in respect of the population included (hospital inpatients, hospital outpatients or primary care patients), the exclusion criteria, the inclusion of distal deep vein thrombosis and the use of D-dimer. The reliability and applicability of the scores in the context of specific subgroups (inpatients, cancer patients, elderly patients and those with recurrent deep vein thrombosis) remains controversial. Conclusion Detailed knowledge of the development of the various clinical prediction scores for deep vein thrombosis is essential in understanding the power, generalisability and limitations of these clinical tools.
authors.affiliation: 1 Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: Marina
authors.initials: M
authors.lastname: Kafeza
authors.affiliation: 1 Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.|2 Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Shalhoub
authors.affiliation: 2 Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Nina
authors.initials: N
authors.lastname: Salooja
authors.affiliation: 2 Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Bingham
authors.affiliation: 3 Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: Konstantina
authors.initials: K
authors.lastname: Spagou
authors.affiliation: 1 Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.|2 Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Alun H
authors.initials: AH
authors.lastname: Davies
mesh_terms: D003657:Decision Making; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D020246:Venous Thrombosis / Q000097:blood* / Q000175:diagnosis*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Deep vein thrombosis; clinical prediction rule; clinical scores; pretest probability