Performance of Wells Score for Deep Vein Thrombosis in the Inpatient Setting
The Wells score to determine the pretest probability of deep vein thrombosis (DVT) was validated in outpatient settings, but it is unclear whether it applies to inpatients. To evaluate the utility of the Wells score for risk stratification of inpatients with suspected DVT. A prospective study was co...
Uložené v:
| Vydané v: | JAMA internal medicine Ročník 175; číslo 7; s. 1112 - 1117 |
|---|---|
| Hlavní autori: | , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
| Vydavateľské údaje: |
United States
01.07.2015
|
| Predmet: | |
| ISSN: | 2168-6114 |
| On-line prístup: | Zistit podrobnosti o prístupe |
| Tagy: |
Pridať tag
Žiadne tagy, Buďte prvý, kto otaguje tento záznam!
|
| Abstract | The Wells score to determine the pretest probability of deep vein thrombosis (DVT) was validated in outpatient settings, but it is unclear whether it applies to inpatients.
To evaluate the utility of the Wells score for risk stratification of inpatients with suspected DVT.
A prospective study was conducted in a 793-bed quaternary care, academic hospital using Wells score clinical predictor findings entered by health care professionals in a computerized physician order entry system at the time lower-extremity venous duplex ultrasound studies were ordered. All adult inpatients suspected of having lower-extremity DVT who underwent lower-extremity venous duplex ultrasound studies between November 1, 2012, and December 31, 2013, were included. Patients with DVT diagnosed within the prior 3 months were excluded. For patients undergoing multiple lower-extremity venous duplex ultrasound studies, only the first was included.
Our primary outcome was the Wells score's utility for risk stratification among inpatients with suspected DVT as measured by the difference in incidence of proximal DVT among the 3 Wells score categories (low, moderate, and high pretest probability), the discrimination accuracy of the Wells score categories as the area under the receiver operating characteristics curve, the failure rate of Wells score prediction, and the efficiency of the Wells score to exclude DVT.
In a study cohort of 1135 inpatients, 137 (12.1%) had proximal DVT. Proximal DVT incidence in low, moderate, and high pretest probability groups was 5.9% (8 of 135), 9.5% (48 of 506), and 16.4% (81 of 494), respectively (P < .001). The area under the receiver operating characteristics curve for the discriminatory accuracy of the Wells score for risk of proximal DVT identified on lower-extremity venous duplex ultrasound studies was 0.60. The failure rate of the Wells score to classify patients with a low pretest probability was 5.9% (95% CI, 3.0%-11.3%); the efficiency was 11.9% (95% CI, 10.1%-13.9%).
The Wells score performed only slightly better than chance for discrimination of risk for DVT in hospitalized patients. It had a higher failure rate and a lower efficiency in the inpatient setting compared with that reported in the outpatient literature. Therefore, the Wells score risk stratification is not sufficient to rule out DVT or influence management decisions in the inpatient setting. |
|---|---|
| AbstractList | IMPORTANCEThe Wells score to determine the pretest probability of deep vein thrombosis (DVT) was validated in outpatient settings, but it is unclear whether it applies to inpatients.OBJECTIVETo evaluate the utility of the Wells score for risk stratification of inpatients with suspected DVT.DESIGN, SETTING, AND PARTICIPANTSA prospective study was conducted in a 793-bed quaternary care, academic hospital using Wells score clinical predictor findings entered by health care professionals in a computerized physician order entry system at the time lower-extremity venous duplex ultrasound studies were ordered. All adult inpatients suspected of having lower-extremity DVT who underwent lower-extremity venous duplex ultrasound studies between November 1, 2012, and December 31, 2013, were included. Patients with DVT diagnosed within the prior 3 months were excluded. For patients undergoing multiple lower-extremity venous duplex ultrasound studies, only the first was included.MAIN OUTCOMES AND MEASURESOur primary outcome was the Wells score's utility for risk stratification among inpatients with suspected DVT as measured by the difference in incidence of proximal DVT among the 3 Wells score categories (low, moderate, and high pretest probability), the discrimination accuracy of the Wells score categories as the area under the receiver operating characteristics curve, the failure rate of Wells score prediction, and the efficiency of the Wells score to exclude DVT.RESULTSIn a study cohort of 1135 inpatients, 137 (12.1%) had proximal DVT. Proximal DVT incidence in low, moderate, and high pretest probability groups was 5.9% (8 of 135), 9.5% (48 of 506), and 16.4% (81 of 494), respectively (P < .001). The area under the receiver operating characteristics curve for the discriminatory accuracy of the Wells score for risk of proximal DVT identified on lower-extremity venous duplex ultrasound studies was 0.60. The failure rate of the Wells score to classify patients with a low pretest probability was 5.9% (95% CI, 3.0%-11.3%); the efficiency was 11.9% (95% CI, 10.1%-13.9%).CONCLUSIONS AND RELEVANCEThe Wells score performed only slightly better than chance for discrimination of risk for DVT in hospitalized patients. It had a higher failure rate and a lower efficiency in the inpatient setting compared with that reported in the outpatient literature. Therefore, the Wells score risk stratification is not sufficient to rule out DVT or influence management decisions in the inpatient setting. The Wells score to determine the pretest probability of deep vein thrombosis (DVT) was validated in outpatient settings, but it is unclear whether it applies to inpatients. To evaluate the utility of the Wells score for risk stratification of inpatients with suspected DVT. A prospective study was conducted in a 793-bed quaternary care, academic hospital using Wells score clinical predictor findings entered by health care professionals in a computerized physician order entry system at the time lower-extremity venous duplex ultrasound studies were ordered. All adult inpatients suspected of having lower-extremity DVT who underwent lower-extremity venous duplex ultrasound studies between November 1, 2012, and December 31, 2013, were included. Patients with DVT diagnosed within the prior 3 months were excluded. For patients undergoing multiple lower-extremity venous duplex ultrasound studies, only the first was included. Our primary outcome was the Wells score's utility for risk stratification among inpatients with suspected DVT as measured by the difference in incidence of proximal DVT among the 3 Wells score categories (low, moderate, and high pretest probability), the discrimination accuracy of the Wells score categories as the area under the receiver operating characteristics curve, the failure rate of Wells score prediction, and the efficiency of the Wells score to exclude DVT. In a study cohort of 1135 inpatients, 137 (12.1%) had proximal DVT. Proximal DVT incidence in low, moderate, and high pretest probability groups was 5.9% (8 of 135), 9.5% (48 of 506), and 16.4% (81 of 494), respectively (P < .001). The area under the receiver operating characteristics curve for the discriminatory accuracy of the Wells score for risk of proximal DVT identified on lower-extremity venous duplex ultrasound studies was 0.60. The failure rate of the Wells score to classify patients with a low pretest probability was 5.9% (95% CI, 3.0%-11.3%); the efficiency was 11.9% (95% CI, 10.1%-13.9%). The Wells score performed only slightly better than chance for discrimination of risk for DVT in hospitalized patients. It had a higher failure rate and a lower efficiency in the inpatient setting compared with that reported in the outpatient literature. Therefore, the Wells score risk stratification is not sufficient to rule out DVT or influence management decisions in the inpatient setting. |
| Author | Ip, Ivan K Goldhaber, Samuel Z Silveira, Patricia C Benson, Carol B Khorasani, Ramin Piazza, Gregory |
| Author_xml | – sequence: 1 givenname: Patricia C surname: Silveira fullname: Silveira, Patricia C organization: Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts – sequence: 2 givenname: Ivan K surname: Ip fullname: Ip, Ivan K organization: Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts – sequence: 3 givenname: Samuel Z surname: Goldhaber fullname: Goldhaber, Samuel Z organization: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts – sequence: 4 givenname: Gregory surname: Piazza fullname: Piazza, Gregory organization: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts – sequence: 5 givenname: Carol B surname: Benson fullname: Benson, Carol B organization: Division of Ultrasound, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts – sequence: 6 givenname: Ramin surname: Khorasani fullname: Khorasani, Ramin organization: Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts4Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25985219$$D View this record in MEDLINE/PubMed |
| BookMark | eNo1UM1KAzEYDKLYWvsKmqOXrfnZ3SZHqVULBYVWPS5J9lub0k3WJD349gascxlmGIZhrtC58w4QuqVkRgmh93vVK-sSBNdDO2OEVjNai_kZGrPMRU1pOULTGPckQxBScn6JRqySomJUjtH6DULnQ6-cAew7_AmHQ8Qb4wPg7ONHgAF_gHV4uwu-1z7aiLNKO8ArN6hkwSW8gZSs-7pGF506RJieeILen5bbxUuxfn1eLR7WheJSpAKM4JXReb4kIAwo6OZKt6rsatYyVbYtZyXhQOVcS8245qYkmgjNREu5MWyC7v56h-C_jxBT09to8nLlwB9jQ2tZypoKWeXozSl61PmhZgi2V-Gn-X-A_QKiLmHi |
| CitedBy_id | crossref_primary_10_1016_j_mayocp_2024_02_025 crossref_primary_10_7759_cureus_37416 crossref_primary_10_1016_j_jcrc_2022_153992 crossref_primary_10_1186_s12959_024_00633_4 crossref_primary_10_1002_jum_70050 crossref_primary_10_1016_j_thromres_2021_02_020 crossref_primary_10_7759_cureus_8813 crossref_primary_10_1186_s42492_025_00204_y crossref_primary_10_1016_S0140_6736_16_30514_1 crossref_primary_10_1111_jth_13536 crossref_primary_10_1177_1358863X21994672 crossref_primary_10_1186_s42466_025_00396_x crossref_primary_10_1007_s11606_017_4170_3 crossref_primary_10_1177_0268355517718762 crossref_primary_10_12998_wjcc_v9_i31_9406 crossref_primary_10_1016_j_jvsv_2018_11_010 crossref_primary_10_1097_EBP_0000000000000805 crossref_primary_10_2106_JBJS_JOPA_24_00012 crossref_primary_10_1160_TH16_10_0823 crossref_primary_10_1016_j_amjms_2019_01_011 crossref_primary_10_1007_s10620_024_08418_5 crossref_primary_10_1177_2333794X19859161 crossref_primary_10_7134_phlebol_24_16 crossref_primary_10_1002_jum_70046 crossref_primary_10_1111_imj_13524 crossref_primary_10_1177_10760296241263856 crossref_primary_10_1111_jgs_14279 crossref_primary_10_2147_CLEP_S501062 crossref_primary_10_1038_s41598_017_04843_x crossref_primary_10_1016_j_rce_2020_03_009 crossref_primary_10_1038_s41598_022_10002_8 crossref_primary_10_1007_s11239_024_02963_6 crossref_primary_10_1001_jama_2020_17272 crossref_primary_10_1016_j_heliyon_2025_e42928 crossref_primary_10_1002_jhm_2598 crossref_primary_10_1186_s12872_024_04270_7 crossref_primary_10_1186_s12957_023_03170_y crossref_primary_10_1111_crj_13473 crossref_primary_10_1177_10760296231187392 crossref_primary_10_3389_fsurg_2023_1041578 crossref_primary_10_1007_s11739_019_02098_0 crossref_primary_10_1007_s00402_023_05085_5 crossref_primary_10_1016_j_compbiomed_2024_108447 crossref_primary_10_3390_jcm12227009 crossref_primary_10_1016_j_jvsv_2020_04_009 crossref_primary_10_1097_MD_0000000000042234 crossref_primary_10_1007_s11606_019_05120_5 crossref_primary_10_1097_MOH_0000000000000339 crossref_primary_10_1038_s41598_024_70464_w crossref_primary_10_1097_GME_0000000000002305 crossref_primary_10_1136_bmj_2022_071058 crossref_primary_10_1177_1076029621991185 crossref_primary_10_1016_j_jvn_2022_05_001 crossref_primary_10_1038_s41598_024_57711_w crossref_primary_10_1007_s11739_019_02066_8 crossref_primary_10_36660_abc_20220213 crossref_primary_10_12677_NS_2024_132027 crossref_primary_10_1038_nrcardio_2015_106 crossref_primary_10_1177_1538574420946569 crossref_primary_10_1007_s12028_019_00792_7 crossref_primary_10_1111_ggi_13873 crossref_primary_10_1177_0268355516678729 crossref_primary_10_1177_10760296251375842 crossref_primary_10_3390_jcm13226795 crossref_primary_10_1016_j_thromres_2017_10_006 crossref_primary_10_1093_neuonc_noad059 crossref_primary_10_1111_hex_70059 crossref_primary_10_1016_j_ccm_2018_04_001 crossref_primary_10_1016_j_jss_2019_03_052 crossref_primary_10_1016_j_ajem_2015_11_028 crossref_primary_10_7759_cureus_45790 crossref_primary_10_1016_j_thromres_2025_109395 |
| ContentType | Journal Article |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1001/jamainternmed.2015.1687 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE - Academic MEDLINE |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 2168-6114 |
| EndPage | 1117 |
| ExternalDocumentID | 25985219 |
| Genre | Clinical Trial Journal Article |
| GroupedDBID | 0R~ 4.4 53G AAGZG AAQQT AARDX AAWTL ABBLC ABJNI ABPMR ACDNT ACGFS ADBBV AENEX AFCHL AHMBA ALMA_UNASSIGNED_HOLDINGS AMJDE ANMPU BRYMA C45 CGR CUY CVF EBD EBS ECM EIF EJD EMOBN EX3 H13 HF~ NPM OB2 OBH OCB OGEVE OHH OVD PQQKQ RAJ SV3 TEORI WH7 WOW YYP ~H1 7X8 |
| ID | FETCH-LOGICAL-a398t-ec835cb00190e8ceaef7abda4f62d2a4dd32403e197b9b23b3c40b08b28d13cc2 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 82 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000357604400013&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| IngestDate | Thu Oct 02 09:44:32 EDT 2025 Mon Jul 21 05:40:37 EDT 2025 |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 7 |
| Language | English |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-a398t-ec835cb00190e8ceaef7abda4f62d2a4dd32403e197b9b23b3c40b08b28d13cc2 |
| Notes | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 |
| PMID | 25985219 |
| PQID | 1694961895 |
| PQPubID | 23479 |
| PageCount | 6 |
| ParticipantIDs | proquest_miscellaneous_1694961895 pubmed_primary_25985219 |
| PublicationCentury | 2000 |
| PublicationDate | 2015-07-01 |
| PublicationDateYYYYMMDD | 2015-07-01 |
| PublicationDate_xml | – month: 07 year: 2015 text: 2015-07-01 day: 01 |
| PublicationDecade | 2010 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | JAMA internal medicine |
| PublicationTitleAlternate | JAMA Intern Med |
| PublicationYear | 2015 |
| References | 25985412 - JAMA Intern Med. 2015 Jul;175(7):1118-9 26524758 - JAMA Intern Med. 2015 Nov;175(11):1873-4 26524761 - JAMA Intern Med. 2015 Nov;175(11):1874 26149487 - Nat Rev Cardiol. 2015 Aug;12(8):449-50 |
| References_xml | – reference: 26149487 - Nat Rev Cardiol. 2015 Aug;12(8):449-50 – reference: 25985412 - JAMA Intern Med. 2015 Jul;175(7):1118-9 – reference: 26524761 - JAMA Intern Med. 2015 Nov;175(11):1874 – reference: 26524758 - JAMA Intern Med. 2015 Nov;175(11):1873-4 |
| SSID | ssj0000800433 |
| Score | 2.4574974 |
| Snippet | The Wells score to determine the pretest probability of deep vein thrombosis (DVT) was validated in outpatient settings, but it is unclear whether it applies... IMPORTANCEThe Wells score to determine the pretest probability of deep vein thrombosis (DVT) was validated in outpatient settings, but it is unclear whether it... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 1112 |
| SubjectTerms | Aged Decision Support Techniques Female Humans Inpatients - statistics & numerical data Male Massachusetts - epidemiology Middle Aged Prospective Studies Risk Assessment Ultrasonography Venous Thrombosis - diagnostic imaging Venous Thrombosis - epidemiology |
| Title | Performance of Wells Score for Deep Vein Thrombosis in the Inpatient Setting |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/25985219 https://www.proquest.com/docview/1694961895 |
| Volume | 175 |
| WOSCitedRecordID | wos000357604400013&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1LS8NAEF7Uinjx_agvVvAazWOT7J5E1KLQlkKr9hb2McFATWpT_f3OJqmeBMFLYEMWwuxk58vMt98QcsFY6rlpLB1fQupgxI8cpYR2NPdcAyFgzKxEXLtxv8_HYzFoEm5lQ6tc7InVRm0KbXPkV14kmO1OIsLr6btju0bZ6mrTQmOZtAKEMtar4zH_zrFYNMSCYEHrasSGsirVhrHGErvCSy_i8e_wsgoznc3_vuAW2WgAJr2pPWKbLEG-Q9Z6TQl9l3QHP0cFaJHSF5hMSjq0apYU79M7gCl9hiyno9dZ8aaKMispjhAo0se8kWGlQ6j40nvkqXM_un1wmpYKjgwEnzugEXFpi5SEC1wDLlAslZEsjXzjS2ZMJdAHnoiVUH6gAs1c5XLlc-MFWvv7ZCUvcjgkNOYm1MZjYQyIwvAR5huEM35gZORpLtvkfGGnBF3W1iFkDsVHmfxYqk0OamMn01pbI8G_MY6IQhz9YfYxWbcrWJNnT0grxQ8WTsmq_pxn5eys8gW89ge9Lz0zwPM |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Performance+of+Wells+Score+for+Deep+Vein+Thrombosis+in+the+Inpatient+Setting&rft.jtitle=JAMA+internal+medicine&rft.au=Silveira%2C+Patricia+C&rft.au=Ip%2C+Ivan+K&rft.au=Goldhaber%2C+Samuel+Z&rft.au=Piazza%2C+Gregory&rft.date=2015-07-01&rft.eissn=2168-6114&rft.volume=175&rft.issue=7&rft.spage=1112&rft.epage=1117&rft_id=info:doi/10.1001%2Fjamainternmed.2015.1687&rft.externalDBID=NO_FULL_TEXT |