Heldner et al reported a model for the diagnosis of cerebral venous thrombosis. This is based on a clinical score plus D-dimer testing. The authors are from the University of Bern and the University of Amsterdam.
Components of model:
(1) clinical score
(2) D-dimer in micrograms per L
Parameters for clinical score:
(1) seizure at presentation
(2) known thrombophilia
(3) oral contraception
(4) duration of symptoms in days
(5) worse headache ever
(6) focal neurological deficit at presentation
|
Parameter
|
Finding
|
Points
|
|
seizure at presentation
|
no
|
0
|
|
|
yes
|
4
|
|
known thrombophilia
|
no
|
0
|
|
|
yes
|
4
|
|
oral contraceptives
|
no
|
0
|
|
|
yes
|
2
|
|
duration of symptoms
|
<= 6 days
|
0
|
|
|
> 6 days
|
2
|
|
worse headache ever
|
no
|
0
|
|
|
yes
|
1
|
|
focal neurological deficit
|
no
|
0
|
|
|
yes
|
1
|
clinical score =
= SUM(points for all 6 parameters)
|
Parameter
|
Finding
|
Points
|
|
D-dimer
|
<= 500 µg/L
|
0
|
|
|
> 500 µg/L
|
3
|
combined score =
= (clinical score) + (points for D-dimer)
Interpretation:
• minimum clinical score: 0
• maximum clinical score: 14
• minimum combined score: 0
• maximum combined score: 17
• All patients with a score >=9 had a cerebral venous thrombosis.
• No patients with cerebral venous thrombosis had a low probability by the clinical score (score 0 to 2) with a D-dimer < 500 µg/L.
Performance:
• A combined score >= 6 had an area under the ROC curve of 0.937.
