疑似深静脉血栓的DAYS评分的外部验证

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2025-05-01 DOI:10.1016/j.rpth.2025.102885

Thor–David Halstensen , Camilla Hardeland , Waleed Ghanima , Vigdis Abrahamsen Grøndahl , Aliaksandr Hubin , Camilla Tøvik Jørgensen , Kerstin de Wit , Mazdak Tavoly

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引用次数: 0

摘要

诊断深静脉血栓（DVT）包括临床评估、d -二聚体检测和影像学检查。DAYS评分是一种新型的2项预测工具，结合d -二聚体，显示出良好的性能，但需要外部验证。目的本研究旨在验证两种DVT预测评分：DAYS评分和新开发的DVT评分。方法数据收集自一项前瞻性挪威DVT管理研究(2015-2018；NCT02486445)。DAYS评分包括2个项目（DVT最有可能的诊断和小腿肿胀），而新的评分包括深静脉压痛和既往静脉血栓栓塞。如果没有项目存在并且d -二聚体是<；1.0 μg/mL或存在≥1项且d -二聚体为<；0.5μg / mL。2层Wells评分作为参考。安全性定义为漏诊DVT病例数除以排除DVT的患者总数，并设定为2%。结果1312例患者(中位年龄64岁；IQR， 52-73岁；55%女性)，261例（20.0%）确诊深静脉血栓。455例（34.6%）患者的DAYS评分排除了DVT，其中11例被诊断为DVT(失败率2.4%；95% ci, 1.2-4.2)。新评分排除了519例（39.6%）DVT，漏诊7例(失败率1.3%；95% ci, 0.5-2.8)。在271例（20.6%）患者中，Wells评分排除了DVT，仅有2例确诊为DVT。结论DAYS评分和新评分均显示较低的失败率，但均超过了预先设定的安全阈值。

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External validation of the DAYS score for suspected deep vein thrombosis

Background

Diagnosing deep vein thrombosis (DVT) involves clinical assessment, D-dimer testing, and imaging. The DAYS score, a novel 2-item prediction tool combined with D-dimer, demonstrated promising performance but required external validation.

Objectives

This study aimed to validate 2 DVT prediction scores: the DAYS score and a newly developed DVT score.

Methods

Data were collected from a prospective Norwegian DVT management study (2015-2018; NCT02486445). The DAYS score includes 2 items (DVT most likely diagnosis and calf swelling), while the new score comprises tenderness along the deep veins and previous venous thromboembolism. DVT was considered excluded if no items were present and D-dimer was < 1.0 μg/mL or if ≥1 item was present and D-dimer was < 0.5 μg/mL. The 2-tier Wells score served as the reference. Safety was defined as the number of missed DVT cases divided by the total number of patients classified as having DVT excluded and was set at 2%.

Results

Among 1312 patients (median age, 64 years; IQR, 52-73 years; 55% women), 261 (20.0%) had confirmed DVT. The DAYS score excluded DVT in 455 patients (34.6%), of whom 11 were diagnosed with DVT (failure rate, 2.4 %; 95% CI, 1.2-4.2). The new score excluded DVT in 519 patients (39.6%) and missed 7 cases with confirmed DVT (failure rate, 1.3%; 95% CI, 0.5-2.8). The Wells score excluded DVT in 271 patients (20.6%), missing only 2 cases with confirmed DVT.