Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
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SHR Neuro Krebs Kardio Lipid Stoffw Microb
Kleinjan, A; Di Nisio, M; Beyer-Westendorf, J; Camporese, G; Cosmi, B; Ghirarduzzi, A; Kamphuisen, PW; Otten, HM; Porreca, E; Aggarwal, A; Brodmann, M; Guglielmi, MD; Iotti, M; Kaasjager, K; Kamvissi, V; Lerede, T; Marschang, P; Meijer, K; Palareti, G; Rickles, FR; Righini, M; Rutjes, AW; Tonello, C; Verhamme, P; Werth, S; van Wissen, S; Büller, HR.
Safety and feasibility of a diagnostic algorithm combining clinical probability, d-dimer testing, and ultrasonography for suspected upper extremity deep venous thrombosis: a prospective management study.
Ann Intern Med. 2014; 160(7):451-457
Doi: 10.7326/M13-2056
Web of Science
PubMed
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- Brodmann Marianne
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- Abstract:
- Although well-established for suspected lower limb deep venous thrombosis, an algorithm combining a clinical decision score, d-dimer testing, and ultrasonography has not been evaluated for suspected upper extremity deep venous thrombosis (UEDVT). To assess the safety and feasibility of a new diagnostic algorithm in patients with clinically suspected UEDVT. Diagnostic management study. (ClinicalTrials.gov: NCT01324037) SETTING: 16 hospitals in Europe and the United States. 406 inpatients and outpatients with suspected UEDVT. The algorithm consisted of the sequential application of a clinical decision score, d-dimer testing, and ultrasonography. Patients were first categorized as likely or unlikely to have UEDVT; in those with an unlikely score and normal d-dimer levels, UEDVT was excluded. All other patients had (repeated) compression ultrasonography. The primary outcome was the 3-month incidence of symptomatic UEDVT and pulmonary embolism in patients with a normal diagnostic work-up. The algorithm was feasible and completed in 390 of the 406 patients (96%). In 87 patients (21%), an unlikely score combined with normal d-dimer levels excluded UEDVT. Superficial venous thrombosis and UEDVT were diagnosed in 54 (13%) and 103 (25%) patients, respectively. All 249 patients with a normal diagnostic work-up, including those with protocol violations (n = 16), were followed for 3 months. One patient developed UEDVT during follow-up, for an overall failure rate of 0.4% (95% CI, 0.0% to 2.2%). This study was not powered to show the safety of the substrategies. d-Dimer testing was done locally. The combination of a clinical decision score, d-dimer testing, and ultrasonography can safely and effectively exclude UEDVT. If confirmed by other studies, this algorithm has potential as a standard approach to suspected UEDVT. None.
- Find related publications in this database (using NLM MeSH Indexing)
- Algorithms -
- Decision Support Techniques -
- Feasibility Studies -
- Fibrin Fibrinogen Degradation Products - analysis
- Humans -
- Probability -
- Prospective Studies -
- Ultrasonography, Doppler, Color -
- Upper Extremity Deep Vein Thrombosis - diagnosis Upper Extremity Deep Vein Thrombosis - ultrasonography