开发和内部验证的一个简单的临床评分估计的概率深静脉血栓的门诊急诊科患者。

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2024-10-29 eCollection Date: 2024-11-01 DOI:10.1016/j.rpth.2024.102608

Thor-David Halstensen, Camilla Hardeland, Waleed Ghanima, Vigdis Abrahamsen Grøndahl, Aliaksandr Hubin, Mazdak Tavoly

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引用次数: 0

摘要

背景：Wells评分包含主观因素，使医生不愿意使用Wells评分或导致其使用错误。目的：开发并内部验证一种客观、简单的评估疑似深静脉血栓形成（DVT）的预测评分，其安全性与Wells评分相当。方法：我们使用Ri-Schedule研究（NCT02486445）的数据进行了事后分析，该研究涉及挪威Østfold医院急诊科（2015-2018）的疑似DVT患者。候选变量通过自举技术确定，以确诊的DVT诊断作为结果变量。评估敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV），并与2层Wells评分进行比较。结果：1312例患者中位年龄64岁[IQR， 52-73]；55%为女性)，19.9%诊断为深静脉血栓。对30个变量的探索发现，深静脉的压痛和以前的静脉血栓栓塞是重要的预测因素（在1000个自举样本中选择频率为60%）。得出的评分将450名患者分为0项不太可能发生DVT，其中8.0%被诊断为DVT，而根据Wells评分，不太可能发生DVT的患者为8.2%。与Wells评分相比，衍生评分的敏感性为86.2 (95% CI, 81.4-90.2) vs 80.1 (95% CI, 74.7-84.8)，特异性为39.4 (95% CI, 36.4-42.4) vs 55.3 (95% CI, 52.2-58.3)， NPV为92.0 (95% CI, 89.4-94.0) vs 91.8 (95% CI, 89.7-93.5)， PPV为26.1 (95% CI, 24.8-27.5) vs 30.8 （95% CI, 28.9-32.8）。结论：导出的DVT评分具有2个客观变量，其安全性与Wells评分相当。然而，在临床使用之前必须进行外部验证。

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Development and internal validation of a simple clinical score for the estimation of the probability of deep vein thrombosis in outpatient emergency department patients.

Background: Wells score comprises subjective elements, making physicians reluctant to use Wells score or cause them to use it incorrectly.

Objectives: To develop and internally validate a prediction score that is objective and simple for evaluating suspected deep vein thrombosis (DVT), with a safety comparable with that of Wells score.

Methods: We performed a post hoc analysis using data from the Ri-Schedule study (NCT02486445) involving suspected DVT patients at Østfold Hospital's Emergency Department, Norway (2015-2018). Candidate variables were identified through bootstrapping technique, with a confirmed DVT diagnosis as the outcome variable. Sensitivity, specificity, negative predictive value (NPV), and positive predictive values (PPV) were estimated and compared with the 2-tier Wells score.

Results: Among 1312 patients (median age, 64 years [IQR, 52-73]; 55% women), 19.9% were diagnosed with DVT. Exploration of 30 variables identified tenderness along deep veins and previous venous thromboembolism as significant predictors (selection frequency >60% in 1000 bootstrapping samples). The derived score categorized 450 patients with 0 items as unlikely to have DVT, of whom 8.0% were diagnosed with DVT, compared with 8.2% in DVT unlikely category according to Wells score. Compared with Wells score, the derived score demonstrated sensitivity of 86.2 (95% CI, 81.4-90.2) vs 80.1 (95% CI, 74.7-84.8), specificity of 39.4 (95% CI, 36.4-42.4) vs 55.3 (95% CI, 52.2-58.3), NPV of 92.0 (95% CI, 89.4-94.0) vs 91.8 (95% CI, 89.7-93.5), and PPV of 26.1 (95% CI, 24.8-27.5) vs 30.8 (95% CI, 28.9-32.8). When incorporating D-dimer cutoff of <0.5 µg/mL, the derived score had sensitivity of 99.6 (95% CI, 97.9-99.9), specificity of 16.1 (95% CI, 13.1-18.4), NPV of 99.4 (95% CI, 96.0-99.9), and PPV of 22.8 (95% CI, 22.3-23.3).

Conclusion: The derived DVT score, with 2 objective variables, had a comparable safety with that of the Wells score. However, an external validation is mandated prior to clinical use.

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