Alfonso Iorio, MD
In patients with suspected deep venous thrombosis (DVT), how do the Wells rule (WR) and a primary care rule (PCR) compare for ruling out DVT in a primary care setting?
Prospective cohort study comparing 2 previously developed and validated clinical prediction guides (WR and PCR).
> 300 general practices in the Netherlands.
1002 patients ≥ 18 years of age (mean age 58 y, 63% women) with clinically suspected DVT (≥ 1 of swelling, redness, or pain of the lower extremity). Exclusion criteria were use of low-molecular-weight heparin or a vitamin K antagonist.
The WR produced a score by summing the presence of 9 characteristics identified from patient history and physical examination, adjusted by −2 if another diagnosis was at least as likely as DVT. The PCR produced a score by summing the presence of 7 items identified from patient history and physical examination. Patients were classified as low or high risk based on D-dimer results and WR or PCR scores: low risk = negative D-dimer result and WR score ≤ 1 or PCR score ≤ 3; high risk = positive D-dimer result or WR score ≥ 2 or PCR score ≥ 4.
Venous thromboembolic (VTE) events (symptomatic VTE, including fatal or nonfatal pulmonary embolism, or DVT) within 90 days.
14% of patients had confirmed VTE events. Event rates are in the Table.
In patients with suspected deep venous thrombosis, the Wells rule and a primary care rule, when each was combined with D-dimer testing, were useful for ruling out deep venous thrombosis in a primary care setting.
Wells rule (WR) and a primary care rule (PCR) for predicting VTE events* in primary care patients†
*Symptomatic VTE including fatal or nonfatal pulmonary embolism, or deep venous thrombosis.
†VTE = venous thromboembolism; CI defined in Glossary.
Iorio A. The Wells rule and a primary care rule were useful for ruling out deep venous thrombosis in primary care. Ann Intern Med. ;154:JC6–13. doi: 10.7326/0003-4819-154-12-201106210-02013
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Published: Ann Intern Med. 2011;154(12):JC6-13.
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