Revisiting the Past Strengthens the Present: An Evidence-Based Medicine Approach for the Diagnosis of Deep Venous Thrombosis
Authors: Russell D. Hull
Journal: Annals of Internal Medicine (2005)

Editorials5 April 2005Revisiting the Past Strengthens the Present: An Evidence-Based Medicine Approach for the Diagnosis of Deep Venous ThrombosisRussell D. Hull, MBBS, MScRussell D. Hull, MBBS, MScFrom University of Calgary, Foothills Hospital, Calgary, Alberta T2N 2T9, Canada.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-142-7-200504050-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail 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 ...References1. Mclachlin J, Richards T, Paterson JC. An evaluation of clinical signs in the diagnosis of venous thrombosis. Arch Surg. 1962;85:738-44. [PMID: 13932125] CrossrefMedlineGoogle Scholar2. Wells PS, Hirsh J, Anderson DR, Lensing AW, Foster G, Kearon C, et al. Accuracy of clinical assessment of deep-vein thrombosis. Lancet. 1995;345:1326-30. [PMID: 7752753] CrossrefMedlineGoogle Scholar3. Moser KM, LeMoine JR. Is embolic risk conditioned by location of deep venous thrombosis? Ann Intern Med. 1981;94:439-44. [PMID: 7212500] LinkGoogle Scholar4. Kakkar VV, Howe CT, Flanc C, Clarke MB. Natural history of postoperative deep-vein thrombosis. Lancet. 1969;2:230-2. 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Birdwell BG, Raskob GE, Whitsett TL, Durica SS, Comp PC, George JN, et al. The clinical validity of normal compression ultrasonography in outpatients suspected of having deep venous thrombosis. Ann Intern Med. 1998;128:1-7. [PMID: 9424975] LinkGoogle Scholar13. Kearon C, Ginsberg JS, Douketis J, Crowther MA, Turpie AG, Bates SM, et al. A randomized trial of diagnostic strategies after normal proximal vein ultrasonography for suspected deep venous thrombosis: d-dimer testing compared with repeated ultrasonography. Ann Intern Med. 2005;142:490-6. LinkGoogle Scholar14. Stein PD, Hull RD, Ghali WA, Patel KC, Olson RE, Meyers FA, et al. Tracking the uptake of evidence: two decades of hospital practice trends for diagnosing deep vein thrombosis and pulmonary embolism. Arch Intern Med. 2003;163:1213-9. [PMID: 12767959] CrossrefMedlineGoogle Scholar15. Hull RD, Hirsh J, Carter CJ, Jay RM, Ockelford PA, Buller HR, et al. Diagnostic efficacy of impedance plethysmography for clinically suspected deep-vein thrombosis. A randomized trial. Ann Intern Med. 1985;102:21-8. [PMID: 3881068] LinkGoogle Scholar16. Stein PD, Hull RD, Patel KC, Olson RE, Ghali WA, Brant R, et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med. 2004;140:589-602. [PMID: 15096330] LinkGoogle Scholar17. Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003;349:1227-35. [PMID: 14507948] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Russell D. Hull, MBBS, MScAffiliations: From University of Calgary, Foothills Hospital, Calgary, Alberta T2N 2T9, Canada.Disclosures: None disclosed.Corresponding Author: Russell D. Hull, MBBS, MSc, University of Calgary, 601 South Tower, Foothills Hospital, Calgary, Alberta T2N 2T9, Canada; e-mail, jeanne.[email protected]ca. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoA Randomized Trial of Diagnostic Strategies after Normal Proximal Vein Ultrasonography for Suspected Deep Venous Thrombosis: d-Dimer Testing Compared with Repeated Ultrasonography Clive Kearon , Jeffrey S. Ginsberg , James Douketis , Mark A. Crowther , Alexander G. Turpie , Shannon M. 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