| Objectives:To value the evaluation of Wells clinical evaluation table combined with plasma D-dimer detection and color Doppler ultrasound examination in early diagnosis of lower extremity deep venous thrombosis(DVT). In order to improve the efficiency and accuracy of the early diagnosis of DVT.Methods:A retrospective analysis was conducted on 230 patients with suspected lower limb DVT who were hospitalized in QianFoShan Hospital of Shandong Province. All of the patients admitted to the hospital were valued by Wells clinical evaluation scale. And take plasma D-dimer detection and lower extremity venous ultrasonography. For the negative patients, such as lower extremity pain, swelling and other symptoms aggravated or plasma D-dimer levels were elevated (greater than 0. 55 mg/L), take venous ultrasound examination again. Lower extremity deep venous angiography was applied for further diagnosis in patients with uncertain diagnosis. The patients were diagnosed by Wells clinical evaluation scale, plasma D-dimer, color Doppler ultrasound and the three methods combined. Compare the results with the diagnosis of lower extremity deep venous angiography. All of the data were analyzed by using SPSS 18.0 software.Results:1. Wells clinical evaluation table score of 230 patients with suspected DVT:54 high-risk,128 people in danger,48 low-risk.21 patients without DVT:1 high-risk,9 people in danger,11 low-risk.209 patients with DVT:53 high-risk (25.36%),119 in risk (56.94%),37 low risk (17.70%). Wells clinical evaluation table for lower extremity DVT, proximal and distal DVT:Sensitivity was 82.3%,93.8%,81.8%; specificity was 52.4%,39.2%,40.7%; and negative predictive value was 22.9%, 83.3%,22.9%; the positive predictive value was 94.5%,65.9%,91.2%; the Youden index was 0.35,0.33,0.23.2. The average value of plasma D-dimer in 209 patients with DVT is (9.116+ 14.141) mg/L. D-dimer positive (> 0.55mg/L) 182 people,27 were negative. D-dimer of 21 cases without DVT,10 were positive,11 negative. D-dimer for lower limb DVT, proximal and distal DVT:sensitivity was 87.1%,90.6%,87.7%; specificity was 52.4%,25.5%,48.1%, and negative predictive value was 28.9%, 68.4%,34.2%; the positive predictive value was 94.8%,60.4%,92.7%; the Youden index was 0.40,0.16,0.36.3. In 209 cases of lower extremity DVT, the color Doppler ultrasound examination of 200 cases w ere positive,9 cases were negative.2 cases among 21 non-DVT patients were suspected DVT by ultrasound. Color Doppler ultrasound for lower limb DVT, proximal and distal DVT:sensitivity was 95.2%,97.7%,95.6%; specificity was 90.5%,89.2%,88.9%, and negative predictive value was 65.5%, 96.8%,72.7%; the positive predictive value was 99.0%,91.9%,98.5%. Youden index was 0.86,0.87,0.85.4. Wells clinical assessment combined with D-dimer and color Doppler ultrasound for the diagnosis of lower limb DVT, proximal and distal DVT:sensitivity was 96.2%,93.0%,99.0%; specificity was 90.5%,89.2%,88.9%, and negative predictive value was 70.4%,91.0%,92.3%; the positive predictive value was 99.0%,91.5%, 98.5%; the Youden index was 0.87,0.82,0.88.Conclusion:1. In the diagnosis of DVT, the sensitivity and negative predictive values of Wells clinical evaluation table were higher, but specificity poor. It can be used as the first step of diagnosing DVT, and value the risk of DVT. The negative result of D-dimer with high sensitivity can be used to rule out DVT. Color Doppler ultrasound has high sensitivity and specificity, but there are still some false positive rate and false negative rate in clinic.2. The combination of Wells clinical assessment scale with plasma D-dimer test and color Doppler ultrasonography can effectively improve the accuracy and efficiency in early diagnosis of DVT. And reduce the rate of misdiagnosis, the medical cost and save time. It also can guide the therapy plan. |
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