Document Detail


Pretest probability estimation in the evaluation of patients with possible deep vein thrombosis.
MedLine Citation:
PMID:  20825837     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
INTRODUCTION: An estimation of pretest probability is integral to the proper interpretation of a negative compression ultrasound in the diagnostic assessment of lower-extremity deep vein thrombosis. We sought to determine the rate, method, and predictors of pretest probability estimation in such patients.
METHODS: This cross-sectional study of outpatients was conducted in a suburban community hospital in 2006. Estimation of pretest probability was done by enzyme-linked immunosorbent assay d-dimer, Wells criteria, and unstructured clinical impression. Using logistic regression analysis, we measured predictors of documented risk assessment. A cohort analysis was undertaken to compare 3-month thromboembolic outcomes between risk groups.
RESULTS: Among 524 cases, 289 (55.2%) underwent pretest probability estimation using the following methods: enzyme-linked immunosorbent assay d-dimer (228; 43.5%), clinical impression (106; 20.2%), and Wells criteria (24; 4.6%), with 69 (13.2%) patients undergoing a combination of at least two methods. Patient factors were not predictive of pretest probability estimation, but the specialty of the clinician was predictive; emergency physicians (P < .0001) and specialty clinicians (P = .001) were less likely than primary care clinicians to perform risk assessment. Thromboembolic events within 3 months were experienced by 0 of 52 patients in the explicitly low-risk group, 4 (1.8%) of 219 in the explicitly moderate- to high-risk group, and 1 (0.4%) of 226 in the group that did not undergo explicit risk assessment.
CONCLUSIONS: Negative ultrasounds in the workup of deep vein thrombosis are commonly interpreted in isolation apart from pretest probability estimations. Risk assessments varied by physician specialties. Opportunities exist for improvement in the diagnostic evaluation of these patients.
Authors:
David R Vinson; Jason P Patel; Cedric S Irving
Related Documents :
11525697 - Timing of initial administration of low-molecular-weight heparin prophylaxis against de...
9798767 - Meta-analysis of effectiveness of intermittent pneumatic compression devices with a com...
9733157 - Body weight does not predict for anti-xa levels after fixed dose prophylaxis with enoxa...
10709057 - Effect of oral micronized purified flavonoid fraction treatment on leukocyte adhesion m...
17114017 - Prospective trial of laparoscopic nissen fundoplication versus proton pump inhibitor th...
24200137 - Outcomes of surgical versus balloon angioplasty treatment for native coarctation of the...
Publication Detail:
Type:  Journal Article     Date:  2010-04-02
Journal Detail:
Title:  The American journal of emergency medicine     Volume:  29     ISSN:  1532-8171     ISO Abbreviation:  Am J Emerg Med     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-06-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8309942     Medline TA:  Am J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  594-600     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Department of Emergency Medicine, The Permanente Medical Group, Kaiser Permanente Medical Center, Sacramento, CA 95825, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

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


Previous Document:  Etiology of uncompleted exercise stress testing after ED chest pain evaluation.
Next Document:  ED patients: how nonurgent are they? Systematic review of the emergency medicine literature.