Proximal and isolated distal deep vein thrombosis and Wells score accuracy in hospitalized patients

Excerpt

The diagnosis of deep vein thrombosis (DVT) of the lower extremities based on clinical evaluation alone is unreliable due to the poor specificity of the signs and symptoms. While compression ultrasonography is warranted to establish or rule out the diagnosis, DVT is confirmed in only about 20–25% of individuals with a clinical suspicion. In the outpatient setting, diagnostic algorithms that sequentially apply a clinical decision rule (e.g., the Wells rule) and D-dimer testing have been extensively evaluated to decide which individuals could safely avoid imaging to reduce patient burden and healthcare costs [1]. The utility of clinical decision rules for risk stratification is less well established among hospitalized patients. …