Scoring Systems for Diagnosis of Acute Venous Thromboembolism

Abstract

Modern diagnostic strategies for venous thromboembolism almost all rely on an initial assessment of the pretest probability. Assessing the patient's pretest probability for venous thromboembolism is a critical step in the diagnostic strategy and for therapeutic management. Clinical prediction rules combine medical signs and symptoms to provide accurate and reproducible estimates of the probability of a disease before diagnostic tests are performed. The use of scoring systems in patients with suspected acute venous thromboembolism should be encouraged, as their implementation in guidelines for venous thromboembolism diagnosis results in cost-effective care with improved patient outcomes.

Keywords

clinical probability - clinical prediction rules - pulmonary embolism - deep vein thrombosis - diagnostic algorithm

• References

• 1 Oger E. Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale. Thromb Haemost 2000; 83 (05) 657-660
• 2 Barritt DW, Jordan SC. Anticoagulant drugs in the treatment of pulmonary embolism. A controlled trial. Lancet 1960; 1 (7138): 1309-1312
• 3 Agnelli G, Prandoni P, Santamaria MG. , et al; Warfarin Optimal Duration Italian Trial Investigators. Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. N Engl J Med 2001; 345 (03) 165-169
• 4 Kearon C, Gent M, Hirsh J. , et al. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med 1999; 340 (12) 901-907
• 5 Ridker PM, Goldhaber SZ, Danielson E. , et al; PREVENT Investigators. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med 2003; 348 (15) 1425-1434
• 6 Carrier M, Le Gal G, Wells PS, Rodger MA. Systematic review: case-fatality rates of recurrent venous thromboembolism and major bleeding events among patients treated for venous thromboembolism. Ann Intern Med 2010; 152 (09) 578-589
• 7 Le Gal G, Righini M, Roy PM. , et al. Differential value of risk factors and clinical signs for diagnosing pulmonary embolism according to age. J Thromb Haemost 2005; 3 (11) 2457-2464
• 8 Investigators P. ; PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990; 263 (20) 2753-2759
• 9 Salaun PY, Couturaud F, Le Duc-Pennec A. , et al. Noninvasive diagnosis of pulmonary embolism. Chest 2011; 139 (06) 1294-1298
• 10 Ceriani E, Combescure C, Le Gal G. , et al. Clinical prediction rules for pulmonary embolism: a systematic review and meta-analysis. J Thromb Haemost 2010; 8 (05) 957-970
• 11 Righini M, Perrier A, De Moerloose P, Bounameaux H. D-Dimer for venous thromboembolism diagnosis: 20 years later. J Thromb Haemost 2008; 6 (07) 1059-1071
• 12 Righini M, Le Gal G, Aujesky D. , et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet 2008; 371 (9621): 1343-1352
• 13 Perrier A, Roy PM, Sanchez O. , et al. Multidetector-row computed tomography in suspected pulmonary embolism. N Engl J Med 2005; 352 (17) 1760-1768
• 14 Wells PS, Anderson DR, Rodger M. , et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 2003; 349 (13) 1227-1235
• 15 Wells PS, Anderson DR, Rodger M. , et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med 2001; 135 (02) 98-107
• 16 Righini M, Nendaz M, Le Gal G, Bounameaux H, Perrier A. Influence of age on the cost-effectiveness of diagnostic strategies for suspected pulmonary embolism. J Thromb Haemost 2007; 5 (09) 1869-1877
• 17 Konstantinides SV, Torbicki A, Agnelli G. , et al. ESC Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society (ERS). Eur Heart J 2014; 35 (43) 3033-3069
• 18 Moores L, Kline J, Portillo AK. , et al. Multidetector computed tomographic pulmonary angiography in patients with a high clinical probability of pulmonary embolism. J Thromb Haemost 2016; 14 (01) 114-120
• 19 Kearon C, Akl EA, Comerota AJ. , et al. Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: e419s-e94s
• 20 Rodger MA, Maser E, Stiell I, Howley HE, Wells PS. The interobserver reliability of pretest probability assessment in patients with suspected pulmonary embolism. Thromb Res 2005; 116 (02) 101-107
• 21 Le Gal G, Righini M, Roy PM. , et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med 2006; 144 (03) 165-171
• 22 Wells PS, Anderson DR, Rodger M. , et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 2000; 83 (03) 416-420
• 23 Wicki J, Perneger TV, Junod AF, Bounameaux H, Perrier A. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med 2001; 161 (01) 92-97
• 24 Miniati M, Monti S, Bottai M. A structured clinical model for predicting the probability of pulmonary embolism. Am J Med 2003; 114 (03) 173-179
• 25 Stöllberger C, Finsterer J, Lutz W. , et al. Multivariate analysis-based prediction rule for pulmonary embolism. Thromb Res 2000; 97 (05) 267-273
• 26 Wells PS, Anderson DR, Bormanis J. , et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet 1997; 350 (9094): 1795-1798
• 27 Klok FA, Kruisman E, Spaan J. , et al. Comparison of the revised Geneva score with the Wells rule for assessing clinical probability of pulmonary embolism. J Thromb Haemost 2008; 6 (01) 40-44
• 28 Lucassen W, Geersing GJ, Erkens PM. , et al. Clinical decision rules for excluding pulmonary embolism: a meta-analysis. Ann Intern Med 2011; 155 (07) 448-460
• 29 Douma RA, Mos IC, Erkens PM. , et al; Prometheus Study Group. Performance of 4 clinical decision rules in the diagnostic management of acute pulmonary embolism: a prospective cohort study. Ann Intern Med 2011; 154 (11) 709-718
• 30 Hendriksen JM, Geersing GJ, Lucassen WA. , et al. Diagnostic prediction models for suspected pulmonary embolism: systematic review and independent external validation in primary care. BMJ 2015; 351: h4438
• 31 Roy PM, Meyer G, Vielle B. , et al; EMDEPU Study Group. Appropriateness of diagnostic management and outcomes of suspected pulmonary embolism. Ann Intern Med 2006; 144 (03) 157-164
• 32 Glaser JE, Chamarthy M, Haramati LB, Esses D, Freeman LM. Successful and safe implementation of a trinary interpretation and reporting strategy for V/Q lung scintigraphy. J Nucl Med 2011; 52 (10) 1508-1512
• 33 Le Gal G, Bounameaux H. Diagnosing pulmonary embolism: running after the decreasing prevalence of cases among suspected patients. J Thromb Haemost 2004; 2 (08) 1244-1246
• 34 Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2004; 2 (08) 1247-1255
• 35 Kline JA, Courtney DM, Kabrhel C. , et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost 2008; 6 (05) 772-780
• 36 Righini M, Le Gal G, Perrier A, Bounameaux H. More on: clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2005; 3 (01) 188-189 , author reply 190–191
• 37 Penaloza A, Verschuren F, Dambrine S, Zech F, Thys F, Roy PM. Performance of the Pulmonary Embolism Rule-out Criteria (the PERC rule) combined with low clinical probability in high prevalence population. Thromb Res 2012; 129 (05) e189-e193
• 38 Runyon MS, Richman PB, Kline JA. ; Pulmonary Embolism Research Consortium Study Group. Emergency medicine practitioner knowledge and use of decision rules for the evaluation of patients with suspected pulmonary embolism: variations by practice setting and training level. Acad Emerg Med 2007; 14 (01) 53-57
• 39 Chagnon I, Bounameaux H, Aujesky D. , et al. Comparison of two clinical prediction rules and implicit assessment among patients with suspected pulmonary embolism. Am J Med 2002; 113 (04) 269-275
• 40 Anderson DR, Kahn SR, Rodger MA. , et al. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA 2007; 298 (23) 2743-2753
• 41 van Belle A, Büller HR, Huisman MV. , et al; Christopher Study Investigators. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006; 295 (02) 172-179
• 42 Gibson NS, Sohne M, Kruip MJ. , et al; Christopher study investigators. Further validation and simplification of the Wells clinical decision rule in pulmonary embolism. Thromb Haemost 2008; 99 (01) 229-234
• 43 Klok FA, Mos IC, Nijkeuter M. , et al. Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism. Arch Intern Med 2008; 168 (19) 2131-2136
• 44 Roy PM, Durieux P, Gillaizeau F. , et al. A computerized handheld decision-support system to improve pulmonary embolism diagnosis: a randomized trial. Ann Intern Med 2009; 151 (10) 677-686