Usefulness of clinical prediction rules for the diagnosis of venous thromboembolism

A systematic review

Leonardo Tamariz, John Eng, Jodi B. Segal, Jerry A. Krishnan, Dennis T. Bolger, Michael B. Streiff, Mollie W. Jenckes, Eric B. Bass

Research output: Contribution to journalArticle

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Abstract

PURPOSE: To summarize the evidence on the predictive value of clinical prediction rules for the diagnosis of venous thromboembolism. METHODS: We selected all studies in the English literature in which a clinical prediction rule was prospectively validated against a reference standard, and calculated likelihood ratios, predictive values, and the area under the receiver operating characteristic (ROC) curve for each prediction rule. RESULTS: Twenty-three studies met our eligibility criteria: 17 evaluated prediction rules for the diagnosis of deep venous thrombosis and six evaluated rules for pulmonary embolism. The most frequently evaluated prediction rule for deep vein thrombosis was the Wells rule, which had median positive likelihood ratios of 6.62 for patients with a high pretest probability, 1 for moderate pretest probability, and 0.22 for low pretest probability. The median area under the ROC curve was 0.82. Addition of the D-dimer test to the prediction rule increased the median area under the curve to 0.90. The Wells prediction rule was the most commonly studied for pulmonary embolus and had median positive likelihood ratios of 6.75 for those with high pretest probability, 1.82 for moderate pretest probability, and 0.13 for low pretest probability. The median area under the ROC curve was 0.82. CONCLUSION: The Wells prediction rule is useful in identifying patients at low risk of being diagnosed with venous thromboembolism. The addition of a rapid latex D-dimer assay improved the overall performance of the prediction rule.

Original languageEnglish
Pages (from-to)676-684
Number of pages9
JournalAmerican Journal of Medicine
Volume117
Issue number9
DOIs
StatePublished - Nov 1 2004

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Decision Support Techniques
Venous Thromboembolism
ROC Curve
Venous Thrombosis
Literature
Latex
Embolism
Pulmonary Embolism
Area Under Curve
Lung

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Usefulness of clinical prediction rules for the diagnosis of venous thromboembolism : A systematic review. / Tamariz, Leonardo; Eng, John; Segal, Jodi B.; Krishnan, Jerry A.; Bolger, Dennis T.; Streiff, Michael B.; Jenckes, Mollie W.; Bass, Eric B.

In: American Journal of Medicine, Vol. 117, No. 9, 01.11.2004, p. 676-684.

Research output: Contribution to journalArticle

Tamariz, L, Eng, J, Segal, JB, Krishnan, JA, Bolger, DT, Streiff, MB, Jenckes, MW & Bass, EB 2004, 'Usefulness of clinical prediction rules for the diagnosis of venous thromboembolism: A systematic review', American Journal of Medicine, vol. 117, no. 9, pp. 676-684. https://doi.org/10.1016/j.amjmed.2004.04.021
Tamariz, Leonardo ; Eng, John ; Segal, Jodi B. ; Krishnan, Jerry A. ; Bolger, Dennis T. ; Streiff, Michael B. ; Jenckes, Mollie W. ; Bass, Eric B. / Usefulness of clinical prediction rules for the diagnosis of venous thromboembolism : A systematic review. In: American Journal of Medicine. 2004 ; Vol. 117, No. 9. pp. 676-684.
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