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The Rational Clinical Examination
April 8, 1998

Does This Patient Have Deep Vein Thrombosis?

Author Affiliations

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.

JAMA. 1998;279(14):1094-1099. doi:10.1001/jama.279.14.1094

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.

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