Pre-diagnostic management of patients suspicious of deep vein thrombosis
Bibliographic record
Abstract
Background: We analysed the feasibility of the 9th ACCP-guidelines recommendation of starting therapeutic anti- coagulation in patients with a high suspicion of deep vein thrombosis (DVT) and tried to answer the question as to whether it generates a relevant over- or under-use of anti-coagulants in the period prior to the definitive diagnosis. Patients and methods: From March to May 2013 we included 98 consecutive out-patients (mean age 63 ± 17 years, 39 males) suspected of DVT, classifying them according to the 9th ACCP-guidelines recommendations into two groups with high and low clinical suspicion. Those with a high suspicion (Wells Score ≥ 2 and elevated DDimer concentration) initially received Rivaroxaban 15 mg orally. Results: Out of the 80 patients with a high clinical suspicion, 15 (19%) received therapeutic anti-coagulation without any medical necessity because DVT was finally excluded. Out of the 10 patients with a low clinical suspicion, 2 (20%) with a finally proven DVT might have benefited from initial therapeutic anti-coagulation. Females were at a slightly higher risk of receiving therapeutic anti-coagulation unnecessarily. Out of the 45 females with a high clinical suspicion, who received therapeutic anti-coagulation, DVT was excluded in 9 (20%). In males it was 6 (17%) out of 35 patients. The costs for those 80 patients accepting initial anti-coagulation by taking Rivaroxaban 15 mg were €312. By using Certoparin 8000 I.E. the cost would have been €792, which is 150% higher compared to Rivaroxaban within in the same period. Conclusion: Defining patients to have a high suspicion for DVT by Wells score and DDimer is associated with an over-use of therapeutic anticoagulation in almost every fifth patients.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".