Evaluating the Use of a Negative D-Dimer and Modified Low Wells Score in
Excluding above Knee Deep Venous Thrombosis in an Outpatient Population,
Assessing Need for Diagnostic Ultrasound
#MMPMID24967296
Rahiminejad M
; Rastogi A
; Prabhudesai S
; Mcclinton D
; MacCallum P
; Platton S
; Friedman E
ISRN Radiol
2014[]; 2014
(?): 519875
PMID24967296
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Aims. Colour doppler ultrasonography (CDUS) is widely used in the diagnosis of
deep venous thrombosis (DVT); however, the number of scans positive for above
knee DVT is low. The present study evaluates the reliability of the D-dimer test
combined with a clinical probability score (Wells score) in ruling out an above
knee DVT and identifying patients who do not need a CDUS. Materials and Method.
This study is a retrospective audit and reaudit of a total of 816 outpatients
presenting with suspected lower limb DVT from March 2009 to March 2010 and from
September 2011 to February 2012. Following the initial audit, a revised clinical
diagnostic pathway was implemented. Results. In our initial audit, seven patients
(4.9%) with a negative D-dimer and a low Wells score had a DVT. On review, all
seven had a risk factor identified that was not included in the Wells score. No
patient with negative D-dimer and low Wells score with no extra clinical risk
factor had a DVT on CDUS (negative predictive value 100%). A reaudit confirmed
adherence to our revised clinical diagnostic pathway. Conclusions. A negative
D-dimer together with a low Wells score and no risk factors effectively excludes
a lower limb DVT and an ultrasound is unnecessary in these patients.
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