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).
The Rational Clinical Examination section editors: David L. Simel,
MD, MHS, Durham Veterans Affairs Medical Center and Duke University Medical
Center, Durham, NC; Drummond Rennie, MD, Deputy Editor (West), JAMA.
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.
Anand SS, Wells PS, Hunt D, Brill-Edwards P, Cook D, Ginsberg JS. Does This Patient Have Deep Vein Thrombosis?. JAMA. 1998;279(14):1094-1099. doi:10.1001/jama.279.14.1094