This Article  • Full text  • PDF  • Correction  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (95)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Venous Thromboembolism  • Ultrasonography  • The Rational Clinical Examination  • Alert me on articles by topic

Sonia S. Anand, MD, MSc; Philip S. Wells, MD, MSc; Dereck Hunt, MD; Pat Brill-Edwards, MD, MSc; Deborah Cook, MD, MSc; Jeffrey S. Ginsberg, MD

JAMA. 1998;279:1094-1099.

Objective.— To review the validity of the clinical assessment and diagnostic tests in patients with suspected deep vein thrombosis (DVT).

Methods.— A comprehensive review of the literature was conducted by searching MEDLINE from 1966 to April 1997.

Results.— Individual symptoms and signs alone do not reliably predict which patients have DVT. Overall, the diagnostic properties of the clinical examination are poor; the sensitivity of the clinical examination ranges from 60% to 96%, and the specificity ranges from 20% to 72%. However, using specific combinations of risk factors, symptoms, and physical signs for DVT, clinicians can reliably stratify patients with suspected DVT into low, moderate, or high pretest probability categories of actually suffering from DVT. This stratification process in combination with noninvasive testing, such as compression ultrasonography, simplifies the management strategies for patients with suspected DVT.

Conclusions.— Use of a clinical prediction guide that includes specific factors from both the history and physical examination in combination with noninvasive tests simplifies management strategies for patients with suspected DVT.

From the Departments of Medicine (Drs Anand, Hunt, Brill-Edwards, Cook, and Ginsberg) and Clinical Epidemiology (Dr Cook), McMaster University, Hamilton, Ontario; and the Department of Medicine, Ottawa Civic Hospital, Ottawa, Ontario (Dr Wells).

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Emergency department nurse-based outpatient diagnosis of DVT using an evidence-based protocol
Dewar et al.
Emerg. Med. J. 2008;25:411-416.
ABSTRACT | FULL TEXT  

Does This Patient Have Deep Vein Thrombosis?
Wells et al.
JAMA 2006;295:199-207.
ABSTRACT | FULL TEXT  

The Wells Rule Does Not Adequately Rule Out Deep Venous Thrombosis in Primary Care Patients
Oudega et al.
ANN INTERN MED 2005;143:100-107.
ABSTRACT | FULL TEXT  

Meta-Analysis: The Value of Clinical Assessment in the Diagnosis of Deep Venous Thrombosis
Goodacre et al.
ANN INTERN MED 2005;143:129-139.
ABSTRACT | FULL TEXT  

Limited value of patient history and physical examination in diagnosing deep vein thrombosis in primary care
Oudega et al.
Fam Pract 2005;22:86-91.
ABSTRACT | FULL TEXT  

Diagnosis of Lower-Extremity Deep Vein Thrombosis in Outpatients With Musculoskeletal Disorders: A National Survey Study of Physical Therapists
Riddle et al.
ptjournal 2004;84:717-728.
ABSTRACT | FULL TEXT  

Diagnosis of Lower-Extremity Deep Vein Thrombosis in Outpatients
Riddle and Wells
ptjournal 2004;84:729-735.
FULL TEXT  

Does This Patient Have Pulmonary Embolism?
Chunilal et al.
JAMA 2003;290:2849-2858.
ABSTRACT | FULL TEXT  

How we diagnose and treat deep vein thrombosis
Hirsh and Lee
Blood 2002;99:3102-3110.
ABSTRACT | FULL TEXT  

Management of Suspected Deep Venous Thrombosis in Outpatients by Using Clinical Assessment and D-dimer Testing
Kearon et al.
ANN INTERN MED 2001;135:108-111.
ABSTRACT | FULL TEXT  

A Latex D-Dimer Reliably Excludes Venous Thromboembolism
Bates et al.
Arch Intern Med 2001;161:447-453.
ABSTRACT | FULL TEXT  

Aprotinin Decreases Exposure to Allogeneic Blood During Primary Unilateral Total Hip Replacement
Murkin et al.
JBJS 2000;82:675-675.
ABSTRACT | FULL TEXT  

Plasma D-Dimer in the Diagnosis of Deep Vein Thrombosis
Lippi et al.
JAMA 1998;280:1828-1829.
FULL TEXT  

A Strategy to Manage Suspected DVT
JWatch Emergency Med. 1998;1998:4-4.
FULL TEXT