Article Figures & Data
Tables
- Table 1.
Wells Prediction Rule for Diagnosing Deep Venous Thrombosis: Clinical Evaluation Table for Predicting Pretest Probability of Deep Vein Thrombosis
Clinical Characteristic Score Note: Clinical probability: low ≤ 0; intermediate 1–2; high ≥ 3. In patients with symptoms in both legs, the more symptomatic leg is used. Reprinted from The Lancet, Vol 350, Wells PS, Anderson DR, Bormanis J, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management, pp 1795–1798, Copyright 2002, with permission from Elsevier. Active cancer (treatment ongoing, within previous 6 months, or palliative) 1 Paralysis, paresis, or recent plaster immobilization of the lower extremities 1 Recently bedridden >3 days or major surgery within 12 weeks requiring general or regional anesthesia 1 Localized tenderness along the distribution of the deep venous system 1 Entire leg swollen 1 Calf swelling 3 cm larger than asymptomatic side (measured 10 cm below tibial tuberosity) 1 Pitting edema confined to the symptomatic leg 1 Collateral superficial veins (nonvaricose) 1 Alternative diagnosis at least as likely as deep venous thrombosis −2 - Table 2.
Wells Prediction Rule for Diagnosing Pulmonary Embolism: Clinical Evaluation Table for Predicting Pretest Probability of Pulmonary Embolism
Clinical Characteristic Score Note: Clinical probability of pulmonary embolism: low 0–1; intermediate 2–6; high ≥ 7. Reprinted from Am J Med, Vol 113, Chagnon I, Bounameaux H, Aujesky D, et al, Comparison of two clinical prediction rules and implicit assessment among patients with suspected pulmonary embolism, pp 269–275, Copyright 2002, with permission from Elsevier. Previous pulmonary embolism or deep vein thrombosis +1.5 Heart rate >100 beats per minute +1.5 Recent surgery or immobilization +1.5 Clinical signs of deep vein thrombosis +3 Alternative diagnosis less likely than pulmonary embolism +3 Hemoptysis +1 Cancer +1
Additional Files
The Article in Brief
Amir Qaseem , and colleagues
Background Venous thromboembolism refers to two related conditions: deep venous thrombosis (a blood clot that can form, most often in the "deep veins" in the legs, thighs, or pelvis) and pulmonary embolism (which occurs if part or all of the blood clot in the deep vein breaks off and blocks an artery in the lung). There are an estimated 600,000 cases of venous thromboembolism in the United States each year. This guideline presents recommendations to help primary care doctors diagnose deep venous thrombosis and pulmonary embolism.
Annals Journal Club Selection:
Jan/Feb 2007
The Annals Journal Club is designed to encourage a learning community of those seeking to improve health care and health through enhanced primary care. Additional information is available on the Journal Club home page.
The Annals of Family Medicine encourages readers to develop the learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club, and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for: Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care, and then acting on those discussions.1Articles for Discussion
- Segal JB, Eng J, Tamariz LJ, Bass EB. Review of the evidence on diagnosis of deep venous thrombosis and pulmonary embolism. Ann Fam Med. 2007;5(1):63-73.
- Qaseem A, Snow V, Barry P, et al. Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Fam Med. 2007;5(1):57-62.
Discussion Tips
These articles portray a clinical policy guideline developed by two collaborating professional organizations and the evidence review that was used to develop the guideline. We recommend beginning with the clinical practice guideline for an overview of the scientific evidence, and then reading and discussing the evidence review with an emphasis on how often narrowly configured evidence is framed, retrieved, evaluated, synthesized, and translated into recommendations for practice.2,3 (You also may wish to look at the companion management guideline published in this issue, and the accompanying evidence review published in the Annals of Internal Medicine.)Discussion Questions
- What are the recommendations?
- How strong is the evidence for each recommendation?
- What questions were used to frame the evidence review and the guideline development? How well do these questions reflect your questions when faced with a patient in whom you suspect a venous thrombus or a thromboembolism?
- How well does the study selection approach capture all relevant data?
- Were all relevant outcomes considered?
- How were different outcomes and trade-offs considered in making overall recommendations?
- How do you interpret the variability in some of the studies that went into the evidence review? What effect does this variability have on your application of the findings?
- What biases are apparent in how the evidence was evaluated and synthesized?
- How well did the organizations specify their process for developing the guideline from the scientific evidence?
- How practical are the recommendations for use in practice? How applicable are they to your patients and setting?
- What needs for primary care�relevant information does this evidence review and recommendation identify?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals journal club: It�s time to get RADICAL. Ann Fam Med. 2006;4:196-197. Available at: http://annfammed.org/cgi/content/full/4/3/196.
- Hayward RSA, Wilson MC, Tunis SR, Bass EB, Guyatt GH. Users� guides to the medical literature. VIII. How to use clinical practice guidelines. A. Are the recommendations valid? JAMA. 1995;274(7):570-574.
- Wilson MC, Hayward RS, Tunis SR, Bass EB, Guyatt G. Users� guides to the medical literature. VIII. How to use clinical practice guidelines. B. What are the recommendations, and will they help you in caring for your patients? JAMA. 1995;274(20):1630-1632.
Jump to section
- Article
- Abstract
- RECOMMENDATIONS
- INTRODUCTION
- METHODS
- CLINICAL PREDICTION RULES ALONE AND IN COMBINATION WITH D-DIMER ASSAY FOR DIAGNOSIS OF VTE
- TEST CHARACTERISTICS OF D-DIMER ASSAYS ALONE FOR DIAGNOSIS OF VTE
- TEST CHARACTERISTICS OF ULTRASONOGRAPHY FOR DIAGNOSIS OF DVT
- TEST CHARACTERISTICS OF HELICAL COMPUTED AXIAL TOMOGRAPHY FOR DIAGNOSIS OF PULMONARY EMBOLISM
- SUMMARY
- Footnotes
- REFERENCES
- Figures & Data
- eLetters
- Info & Metrics
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