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2015 ; 13
(ä): 18
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Analysis of the accuracy of the Wells scale in assessing the probability of lower
limb deep vein thrombosis in primary care patients practice
#MMPMID26045696
Dybowska M
; Tomkowski WZ
; Kuca P
; Ubysz R
; Jó?wik A
; Chmielewski D
Thromb J
2015[]; 13
(ä): 18
PMID26045696
show ga
BACKGROUND: The clinical picture of deep vein thrombosis (DVT) is nonspecific.
Therefore assessment of the probability of occurrence of DVT plays a very
important part in making a correct diagnosis of DVT. The aim of our prospective
study was to assess the accuracy of the Wells scale in primary care setting in
diagnostic procedure of suspected deep vein thrombosis. METHODS: In the period of
20 - months (from 2007 to 2009) a group of residents from one of the urban
districts of Warsaw, who reported to family doctors (22 primary care physicians
were involved in the study) with symptoms of DVT were assessed on the probability
of occurrence of deep vein thrombosis using the Wells scale. Family doctors were
aware of symptoms of DVT and inclusion patients to this study was based on
clinical suspicion of DVT. Patients were divided into three groups, reflecting
probability of DVT of the lower limbs. To confirm DVT a compression ultrasound
(CUS) test was established. We analyzed the relationship between a qualitative
variable and a variable defined on an original scale (incidence of DVT versus
Wells scale count) using the Mann-Whitney test. Chi-square test compared rates of
DVT events in all clinical probability groups. Patient were follow up during
3 months in primary care setting. RESULTS: In the period of 20 months (from 2007
to 2009) a total number of 1048 patients (male: 250 , female: 798 mean age: 61.4)
with symptoms suggestive of DVT of the lower extremities entered the study. Among
the 100 patients classified in the group with a high probability of DVT of the
lower extremities, 40 (40%) patients (proximal DVT - 13; distal DVT - 27) were
diagnosed with it (95% CI [30.94% -49.80%]). In the group with a moderate
probability consisting of 302 patients, DVT of the lower extremities was
diagnosed in 19 (6.29%) patients (95% CI [4.06% -9.62%]), (proximal DVT - 1;
distal DVT - 18). Of the 646 patients with a low probability of DVT of the lower
extremities distal DVT was diagnosed in 1 (0.15%) patient (95% CI [0.03%
-0.87%]). CONCLUSION: The Wells scale used in primary care setting demonstrated a
high degree of accuracy.