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Use of a Clinical Prediction Score in Patients with Suspected Deep Venous Thrombosis: Two Steps Forward, One Step Back?

James D. Douketis, MD
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From St. Joseph's Healthcare and McMaster University, Hamilton, Ontario, Canada.


Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: James D. Douketis, MD, St. Joseph's Healthcare, Room F-541, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada; e-mail, jdouket@mcmaster.ca.


Ann Intern Med. 2005;143(2):140-142. doi:10.7326/0003-4819-143-2-200507190-00013
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Since antiquity, a measure of a physician's skill and experience has been the ability to predict at the bedside whether a disease is present or absent. In the current era, standardized clinical prediction scores (also known as clinical decision rules) can level the playing field so that physicians, irrespective of experience, can obtain an estimate of disease likelihood (12). Clinical prediction scores can guide clinical management (for example, Ottawa ankle/knee rules), estimate adverse outcome risk (for example, Detsky score), and determine prognosis (for example, Acute Physiology and Chronic Health Evaluation [APACHE] score). The increasing availability of electronic medical records facilitates the use of clinical prediction scores: After a physician enters the chief complaint or clinical scenario, the computer can display the appropriate clinical prediction score, calculate the score, display the corresponding pretest probability, and even calculate the post-test probabilities for each diagnostic test under consideration (3).

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