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[Validation of a clinical prediction rule for the diagnosis of deep vein thrombosis of the lower limbs in primary care].

Abstract : PURPOSE: Patients with suspected deep vein thrombosis (DVT) are often managed on an outpatient basis. The aim of the study was to validate a clinical prediction rule specifically for use in primary care to help physicians in their decision to start anticoagulant therapy while awaiting ultrasound examination. PATIENTS AND METHODS: Between September 2007 and October 2008, 194 general practitioners prospectively included patients with clinically suspected DVT without clinically suspected pulmonary embolism. All patients underwent a standardized clinical assessment in order to collect items included in the clinical prediction rule (personal history of venous thromboembolism +1, immobilization in previous month+1, estrogen contraceptive+2, active malignancy+3, swelling of the calf+1, the presence of an alternative diagnosis more likely than that of DVT-3. DVT unlikely if score<2, likely if score≥2). RESULTS: Among the 164 included patients, 56 (34%) had DVT of them 28 (17%) had a proximal DVT. Proportions of confirmed DVT were 29% in the unlikely group and 43% in the likely group against 26% and 63% respectively in the derivation study. CONCLUSIONS: This clinical prediction rule might not fulfill the required conditions to be considered as a usable help in the ambulatory management of DVT. Variations of the cut-off value could enhance its performance.
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Submitted on : Friday, July 27, 2012 - 2:36:38 PM
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Aurélien Delluc, Florence Le Pape, Alain Le Bras, Pierre Gagne, G. Taton, et al.. [Validation of a clinical prediction rule for the diagnosis of deep vein thrombosis of the lower limbs in primary care].. La Revue de Médecine Interne, 2012, 33 (5), pp.244-9. ⟨10.1016/j.revmed.2011.12.004⟩. ⟨hal-00721431⟩



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