Document Detail

Ascribing leg symptoms to chronic venous disorders: the construction of a diagnostic score.
MedLine Citation:
PMID:  17980285     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The goal was to create a simple diagnostic scoring system able to differentiate leg symptoms related to chronic venous disorders (CVD) from those produced by other causes.
METHODS: A prospective observational study was done of ambulatory or hospitalized patients from 13 private and five institutional vascular centers. Two groups of patients with leg symptoms were investigated. The CVD-positive (CVD+) patients had clinically documented CVD and significant venous reflux at duplex ultrasound examination, but no arterial, rheumatologic, or neurologic disorders. The CVD-negative (CVD-) patients had disorders of an arterial, rheumatic, or neurologic origin but no clinical or duplex ultrasound signs of CVD. Patients completed a 54-item questionnaire characterizing their symptoms. Items of the diagnostic score were selected as those associated with the highest likelihood ratio (LR) for CVD in a first series of patients. They were combined into a few criteria, the number of which, when validated in a patient, would produce the value of the score for this patient. Selection of the most relevant score was performed through the comparison of the surface area under receiver operating characteristic curves. The construct validity of this score was evaluated through a factor analysis. The diagnostic performance of the scoring system was evaluated in a second series of patients similar to the first series.
RESULTS: In the construction phase, 123 CVD+ patients and 94 CVD- patients were enrolled. The validation series consisted of 92 patients (67 venous and 25 nonvenous). The most efficient scoring system was composed of four combined criteria: sensation of heavy or swollen legs (sensitivity, 0.82; specificity, 0.55; LR, 1.84); associated with itching, impatient legs, or phlebalgia (sensitivity, 0.55; specificity, 0.92; LR, 6.41); worsened by a hot environment or improved by a cold environment (sensitivity, 0.78; specificity, 0.71; LR, 2.72); not worsened by walking (sensitivity, 0.89; specificity, 0.62; LR, 2.33). The score was calculated as the number (0 to 4) of the above criteria validated by the patient, with a threshold level of >3, it was shown to have a high specificity (0.95) and a fair sensitivity (0.75) for CVD. Factor analysis showed the construct validity of the score, and consistent results were found in the validation series.
CONCLUSION: The clinical relevance of this scoring system remains to be evaluated prospectively in standard clinical conditions. However, these results already document that venous symptoms can be differentiated from leg symptoms of other origins.
Patrick H Carpentier; Caroline Poulain; Régine Fabry; Franck Chleir; Bruno Guias; Catherine Bettarel-Binon;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  46     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-11-05     Completed Date:  2007-12-20     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  991-6     Citation Subset:  IM    
Centre de Recherche Universitaire de La Léchère, Grenoble, France.
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MeSH Terms
Chronic Disease
Factor Analysis, Statistical
Health Status Indicators*
Likelihood Functions
Middle Aged
Prospective Studies
ROC Curve
Sensitivity and Specificity
Ultrasonography, Doppler, Duplex
Vascular Diseases / diagnosis*
Venous Insufficiency / diagnosis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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