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Revisiting the Past Strengthens the Present: An Evidence-Based Medicine Approach for the Diagnosis of Deep Venous Thrombosis

Russell D. Hull, MBBS, MSc
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From University of Calgary, Foothills Hospital, Calgary, Alberta T2N 2T9, Canada.


Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Russell D. Hull, MBBS, MSc, University of Calgary, 601 South Tower, Foothills Hospital, Calgary, Alberta T2N 2T9, Canada; e-mail, jeanne.sheldon@calgaryhealthregion.ca.


Ann Intern Med. 2005;142(7):583-585. doi:10.7326/0003-4819-142-7-200504050-00015
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The clinical diagnosis of venous thrombosis is inaccurate because the clinical findings are both insensitive and nonspecific (1). The specificity of clinical diagnosis is low because the symptoms or signs can all be caused by nonthrombotic disorders. Nevertheless, the clinical findings are an important, if not crucial, adjunct to objective diagnostic testing (2). The clinical presentation can be used to stratify patients into 3 categories with a low to moderate to high pretest probability of deep venous thrombosis (2). Combining the pretest probability with objective noninvasive testing of the lower extremity improves the diagnostic outcome. If the clinical probability is low and a noninvasive test result is negative, the post-test probability is sufficiently low to exclude the diagnosis of deep venous thrombosis. If the findings of the pretest probability and the noninvasive test result are discordant, further testing is required (2). Since the pretest probability plays a pivotal role in test selection and interpretation, a well-recorded history and careful physical examination are crucial parts of the diagnostic pathway.

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