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KMID : 1147320170040020062
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Journal of Surgical Ultrasound
2017 Volume.4 No. 2 p.62 ~ p.67
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Comparative Study between the Wells Score and Ultrasonography Screening Test in Patients Hospitalized with Suspected Deep Vein Thrombosis
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Baek Doo-San
Park Byung-Wook
Kim Hyang-Kyoung
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Abstract
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Purpose: Deep vein thrombosis (DVT) is potentially related to fatal complications, such as pulmonary thromboembolism. This study evaluated the validity of screening methods of DVT, such as the Wells score and D-dimer, to identify the most reliable approach for a diagnosis of DVT in hospitalized patients.
Methods: A retrospective review of the complete medical records from 129 patients who were referred to our department to rule out DVT was performed. Patients with suspected DVT were categorized according to the Wells score, which was calculated with their past medical history and their presenting symptoms. The risk of DVT suggested by the Wells score and D-dimer testing was then compared with the actual incidence of DVT confirmed by ultrasonography.
Results: A total of 34 patients out of 129 patients were diagnosed with DVT (26.4%). The corresponding DVT incidences in the low, moderate, and high risk groups categorized by the Wells score were 11% (1 of 9), 23.8% (20 of 84), and 36.1% (13 of 36), respectively. No significant difference was found between the risk of DVT suggested by the Wells score and the actual incidence of DVT confirmed by venous ultrasonography (P = 0.21). The level of the D-dimer was elevated in 81 patients (62.8%). On the other hand, the use of the D-dimer assay alone was not a reliable screening test, as its elevated level failed to predict the actual incidence of suspected DVT (P ＜ 0.001).
Conclusion: The overall prevalence of DVT was higher when a patient was judged clinically to be more likely to have DVT than in the general population. As DVT could not be ruled out completely by the Wells score or D-dimer alone, venous ultrasonography imaging should be performed in patients hospitalized with suspected DVT to confirm the diagnosis.
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KEYWORD
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Deep vein thrombosis, Wells score, Ultrasonography
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