Toll et al developed a simple clinical rule for identifying patients who are at low risk for deep vein thrombosis (DVT) in a leg. A patient at higher risk may benefit from additional studies or closer followup. The authors are from Amsterdam, Maastricht and Utrecht in the Netherlands.
Parameters:
(1) gender
(2) use of hormonal contraceptives
(3) history of surgery during the past month
(4) history of recent leg trauma
(5) history of active cancer during the past 6 months
(6) distention of collateral leg veins
(7) difference in calf circumference
(8) D-dimer assay
|
Parameter |
Finding |
Points |
|
gender |
female |
0 |
|
|
male |
1 |
|
use of hormonal contraception |
no |
0 |
|
|
yes (indicates female gender) |
1 |
|
history of surgery |
no |
0 |
|
|
yes |
1 |
|
recent leg trauma |
yes |
0 |
|
|
no |
1 |
|
history of active cancer |
no |
0 |
|
|
yes |
1 |
|
distention of collateral leg veins |
no |
0 |
|
|
yes |
1 |
|
difference between calf circumference |
< 3 cm |
0 |
|
|
>= 3 cm |
2 |
|
D-dimer assay |
negative |
0 |
|
|
positive |
6 |
where:
• The suspicious calf should have a larger circumference than the apparently normal one.
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 13 (14 if a male takes a hormonal contraceptive)
• A patient with a score >= 4 may be at risk deep vein thrombosis and is referred for ultrasonography.
Limitations:
• The endpoint was a DVT during the 3 months of followup.
• The study was not randomized.
Specialty: Hematology Oncology, Clinical Laboratory
ICD-10: ,
