Validation of a Simplified Diagnostic Algorithm for Deep Vein Thrombosis
Notice bibliographique
Résumé
Background: Evidence-based deep vein thrombosis (DVT) diagnostic algorithms used in the emergency department have been extensively validated, yet they are rarely followed by emergency physicians. The most well-known, the Wells score, is complex containing up to 13 clinical items, making it difficult to consistently apply in the emergency department. All diagnostic algorithms for DVT combine estimations of clinical pretest probability with D-dimer blood testing, and/or ultrasonography. In an effort to simplify DVT diagnostic algorithms, we developed a simplified rule for DVT testing, named the 2DAY algorithm. Objectives: The aims of this study were to evaluate the safety and efficiency of the 2DAY algorithm for DVT diagnosis in the emergency department. Methods: We used patient data from the Canadian multicentre diagnostic management study: the 4D study (NCT02038530), to validate the 2DAY algorithm. Patients were followed to determine if they were diagnosed with venous thromboembolism (proximal DVT or pulmonary embolism) within 90-days following their DVT assessment. The 2DAY algorithm consists of physician's estimate of whether DVT is the patient's most likely diagnosis and the blood D-dimer result to determine if an ultrasound is required. If DVT is the most likely diagnosis, then DVT is excluded with standard threshold of <500 ng/mL. If DVT is not the most likely diagnosis, then DVT is excluded using the age-adjusted D-dimer threshold. If DVT is not excluded based on the D-dimer result, the patient must undergo proximal ultrasound imaging. Repeat ultrasonography is indicated when the patient has a D-dimer is ≥ 1,500 ng/mL and a negative initial proximal ultrasound. The primary analysis was the proportion of patients diagnosed with venous thromboembolism within 90-days who had DVT ruled out by the 2DAY algorithm with the corresponding 95% confidence interval (CI) estimated using the Wilson Score method. Similar analysis was used to estimate the efficiency of the 2DAY algorithm defined as the proportion of patients who did not require an ultrasound. Results: In total, 1497 patients were eligible. Using the 2DAY algorithm, 163 (10.9 %) out of the 1497 patients were diagnosed with DVT. The mean age was 60.3, 41.8% were male, and 5.0% had active cancer. DVT was the most likely diagnosis for 68.1% of patients. From the 1334 patients who had DVT ruled out by the 2DAY algorithm, 10 (0.75%; 95% CI, 0.41-1.37) patients had VTE diagnosed during the 90-day follow-up period. The 2DAY algorithm had an efficiency of 38.6% (578/1497; 95% CI, 36.2-41.1). Conclusions: The 2DAY algorithm, was found to be safe and efficient in ruling out DVT. Before the 2DAY algorithm can be implemented in daily clinical practice, a prospective validation study is required.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,029 | 0,120 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».