Thromboembolism diagnostic criteria: Difference between revisions
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{{Thromboembolism}} | {{Thromboembolism}} | ||
{{CMG}} | {{CMG}} | ||
==Diagnostic Criteria== | ==Diagnostic Criteria== | ||
Diagnostic modalities may differ for [[deep venous thrombosis]] and [[pulmonary embolism]]. Some patients may have the both clinical situations. | Diagnostic modalities may differ for [[deep venous thrombosis]] and [[pulmonary embolism]]. Some patients may have the both clinical situations. | ||
===Probability Scoring=== | |||
===Probability | |||
In 2006, Scarvelis and Wells overviewed a set of [[clinical prediction rule]]s for DVT,<ref>{{cite journal | author = Scarvelis D, Wells P | title = Diagnosis and treatment of deep-vein thrombosis. | journal = CMAJ | volume = 175 | issue = 9 | pages = 1087-92 | year = 2006 | id = PMID 17060659. [http://www.cmaj.ca/cgi/content/full/175/9/1087 Free Full Text] }}</ref> on the heels of a widely adopted set of clinical criteria for pulmonary embolism.<ref>Neff MJ. ACEP releases clinical policy on evaluation and management of pulmonary embolism. ''American Family Physician''. 2003; '''68'''(4):759-?. Available at: [http://www.aafp.org/afp/20030815/practice.html http://www.aafp.org/afp/20030815/practice.html]. Accessed on: December 8, 2006.</ref> <ref name="Wells"> Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000 Mar;83(3):416-20. PMID 10744147</ref> | In 2006, Scarvelis and Wells overviewed a set of [[clinical prediction rule]]s for DVT,<ref>{{cite journal | author = Scarvelis D, Wells P | title = Diagnosis and treatment of deep-vein thrombosis. | journal = CMAJ | volume = 175 | issue = 9 | pages = 1087-92 | year = 2006 | id = PMID 17060659. [http://www.cmaj.ca/cgi/content/full/175/9/1087 Free Full Text] }}</ref> on the heels of a widely adopted set of clinical criteria for pulmonary embolism.<ref>Neff MJ. ACEP releases clinical policy on evaluation and management of pulmonary embolism. ''American Family Physician''. 2003; '''68'''(4):759-?. Available at: [http://www.aafp.org/afp/20030815/practice.html http://www.aafp.org/afp/20030815/practice.html]. Accessed on: December 8, 2006.</ref> <ref name="Wells"> Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000 Mar;83(3):416-20. PMID 10744147</ref> | ||
===Wells | ===Wells Score or Criteria=== | ||
(Possible score -2 to 9) | (Possible score -2 to 9) | ||
| Line 26: | Line 21: | ||
:9) Previously documented DVT -- 1 point | :9) Previously documented DVT -- 1 point | ||
:10) Alternative diagnosis at least as likely -- Subtract 2 points | :10) Alternative diagnosis at least as likely -- Subtract 2 points | ||
====Interpretation==== | ====Interpretation==== | ||
Traditional interpretation <ref name="Wells"> Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000 Mar;83(3):416-20. PMID 10744147</ref> <ref name="Wells2"> Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, Forgie M, Kovacs G, Ward J, Kovacs MJ. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001 Jul 17;135(2):98-107. PMID 11453709</ref> | Traditional interpretation <ref name="Wells"> Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000 Mar;83(3):416-20. PMID 10744147</ref> <ref name="Wells2"> Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, Forgie M, Kovacs G, Ward J, Kovacs MJ. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001 Jul 17;135(2):98-107. PMID 11453709</ref> | ||
* Score >6.0 - High (probability 59% based on pooled data <ref name="pmid17185658">{{cite journal |author=Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, Sos TA, Quinn DA, Leeper KV, Hull RD, Hales CA, Gottschalk A, Goodman LR, Fowler SE, Buckley JD |title=Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II Investigators |journal=Radiology |volume=242 |issue=1 |pages=15-21 |year=2007 |doi=10.1148/radiol.2421060971 | pmid=17185658}}</ref>) | * Score >6.0 - High (probability 59% based on pooled data <ref name="pmid17185658">{{cite journal |author=Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, Sos TA, Quinn DA, Leeper KV, Hull RD, Hales CA, Gottschalk A, Goodman LR, Fowler SE, Buckley JD |title=Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II Investigators |journal=Radiology |volume=242 |issue=1 |pages=15-21 |year=2007 |doi=10.1148/radiol.2421060971 | pmid=17185658}}</ref>) | ||
* Score 2.0 to 6.0 - Moderate (probability 29% based on pooled data<ref name="pmid17185658"/>) | * Score 2.0 to 6.0 - Moderate (probability 29% based on pooled data<ref name="pmid17185658"/>) | ||
* Score <2.0 - Low (probability 15% based on pooled data<ref name="pmid17185658"/>) | * Score <2.0 - Low (probability 15% based on pooled data<ref name="pmid17185658"/>) | ||
====Alternate Interpretation==== | |||
====Alternate | |||
* Score > 4 - [[PE]] likely. Consider diagnostic imaging.<ref name="Wells"> Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000 Mar;83(3):416-20. PMID 10744147</ref> <ref>van Belle A, Büller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, Kramer MH, Kruip MJ, Kwakkel-van Erp JM, Leebeek FW, Nijkeuter M, Prins MH, Sohne M, Tick LW; Christopher Study Investigators. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006 Jan 11;295(2):172-9. PMID 16403929</ref> | * Score > 4 - [[PE]] likely. Consider diagnostic imaging.<ref name="Wells"> Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000 Mar;83(3):416-20. PMID 10744147</ref> <ref>van Belle A, Büller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, Kramer MH, Kruip MJ, Kwakkel-van Erp JM, Leebeek FW, Nijkeuter M, Prins MH, Sohne M, Tick LW; Christopher Study Investigators. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006 Jan 11;295(2):172-9. PMID 16403929</ref> | ||
* Score 4 or less - [[PE]] unlikely. Consider [[D-dimer]] to rule out [[PE]]. | * Score 4 or less - [[PE]] unlikely. Consider [[D-dimer]] to rule out [[PE]]. | ||
==References== | ==References== | ||
{{reflist|2}} | |||
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[[Category:Hematology]] | |||
[[Category:Angiology]] | |||
[[Category:Cardiovascular diseases]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Needs overview]] | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Diagnostic Criteria
Diagnostic modalities may differ for deep venous thrombosis and pulmonary embolism. Some patients may have the both clinical situations.
Probability Scoring
In 2006, Scarvelis and Wells overviewed a set of clinical prediction rules for DVT,[1] on the heels of a widely adopted set of clinical criteria for pulmonary embolism.[2] [3]
Wells Score or Criteria
(Possible score -2 to 9)
- 1) Active cancer (treatment within last 6 months or palliative) -- 1 point
- 2) Calf swelling >3 cm compared to other calf (measured 10 cm below tibial tuberosity) -- 1 point
- 3) Collateral superficial veins (non-varicose) -- 1 point
- 4) Pitting edema (confined to symptomatic leg) -- 1 point
- 5) Swelling of entire leg - 1 point
- 6) Localized pain along distribution of deep venous system -- 1 point
- 7) Paralysis, paresis, or recent cast immobilization of lower extremities -- 1 point
- 8) Recently bedridden > 3 days, or major surgery requiring regional or general anesthetic in past 12 weeks -- 1 point
- 9) Previously documented DVT -- 1 point
- 10) Alternative diagnosis at least as likely -- Subtract 2 points
Interpretation
Traditional interpretation [3] [4]
- Score >6.0 - High (probability 59% based on pooled data [5])
- Score 2.0 to 6.0 - Moderate (probability 29% based on pooled data[5])
- Score <2.0 - Low (probability 15% based on pooled data[5])
Alternate Interpretation
- Score > 4 - PE likely. Consider diagnostic imaging.[3] [6]
- Score 4 or less - PE unlikely. Consider D-dimer to rule out PE.
References
- ↑ Scarvelis D, Wells P (2006). "Diagnosis and treatment of deep-vein thrombosis". CMAJ. 175 (9): 1087–92. PMID 17060659. Free Full Text.
- ↑ Neff MJ. ACEP releases clinical policy on evaluation and management of pulmonary embolism. American Family Physician. 2003; 68(4):759-?. Available at: http://www.aafp.org/afp/20030815/practice.html. Accessed on: December 8, 2006.
- ↑ 3.0 3.1 3.2 Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000 Mar;83(3):416-20. PMID 10744147
- ↑ Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, Forgie M, Kovacs G, Ward J, Kovacs MJ. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001 Jul 17;135(2):98-107. PMID 11453709
- ↑ 5.0 5.1 5.2 Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, Sos TA, Quinn DA, Leeper KV, Hull RD, Hales CA, Gottschalk A, Goodman LR, Fowler SE, Buckley JD (2007). "Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II Investigators". Radiology. 242 (1): 15–21. doi:10.1148/radiol.2421060971. PMID 17185658.
- ↑ van Belle A, Büller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, Kramer MH, Kruip MJ, Kwakkel-van Erp JM, Leebeek FW, Nijkeuter M, Prins MH, Sohne M, Tick LW; Christopher Study Investigators. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006 Jan 11;295(2):172-9. PMID 16403929