Predicting deep venous thrombosis in pregnancy : external validation of the LEFT clinical prediction rule

Article Article scientifique Article Predicting deep venous thrombosis in pregnancy : external validation of the LEFT clinical prediction rule eng 2012-10-12 2013-04 author Righini Marc Philip 0000-0003-1211-2969 Division of Angiology and Hemostasis, Department of Medical Specialties, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland. marc.righini@hcuge.ch 38989 Département de médecine (DEMED) author Jobic Christelle author Boehlen Françoise 33004 author Broussaud Jean author Becker François 814216 author Jaffrelot Morgan author Blondon Marc 0000-0001-7032-9491 503046 Département de médecine (DEMED) author Guias Bruno author Le Gal Grégoire EDVIGE study group collaborator Bounameaux Henri 25481 Décanat et administration de la faculté de médecine (ADMED) collaborator Cirafici Paul 29548 collaborator De Moerloose Philippe 26335 collaborator Fontana Pierre 0000-0003-1546-0774 135328 Département de médecine (DEMED) collaborator Gueddi Salah 536896 545-548 10.3324/haematol.2012.072009 23065510 0390-6078 PMC3659985 https://haematologica.org/article/view/6621 The assessment of clinical probability represents an important step in the diagnostic strategy of patients with suspected deep vein thrombosis. The recently derived LEFt clinical prediction rule for pregnant women combines three variables: symptoms in the left leg (L), calf circumference difference of 2 centimeters or over (E for edema) and first trimester presentation (Ft) but is lacking an external validation. The LEFt rule was computed among pregnant women with suspected deep vein thrombosis who were included in a multicenter prospective diagnostic management outcome study. We calculated the proportion of women and the prevalence of deep vein thrombosis in each probability group, along with the diagnostic performances of the LEFt rule. All variables needed to compute the rule could be retrieved in 157 of the 167 pregnant women with suspected deep vein thrombosis. The prevalence of confirmed deep vein thrombosis was 13 of 157 (8.3%). The LEFt rule was negative in 46 (29%) women. A deep vein thrombosis was diagnosed in 13 of 111 (11.7%, 95% Confidence Interval (CI): 8.3-20.9%) of women with at least one of the LEFt criteria, as compared with none of 46 (0.0%, 95%CI: 0.0-7.9%) of women with none of the LEFt criteria. These results suggest that a negative LEFt rule accurately identifies pregnant women in whom the proportion of confirmed deep vein thrombosis appears to be very low. The rule should not be used as stand-alone test for excluding DVT during pregnancy, but might rather be implemented in a diagnostic strategy in association with D-dimer measurement and compression ultrasonography. Adult Edema / diagnosis Female Humans Leg / blood supply Leg / pathology Medical History Taking / methods Medical History Taking / statistics & numerical data Pregnancy Pregnancy Complications, Hematologic / diagnosis Pregnancy Trimester, First Prospective Studies ROC Curve Reproducibility of Results Venous Thrombosis / diagnosis Dewey 616 Swiss National Science Foundation A diagnostic strategy to rule out pulmonary embolism during pregnancy 120760 CH Projects 56 Département de médecine 221 false 477 Maladie thromboembolique veineuse 808 11 Plaquettes et antithrombotiques 13 Haematologica 98 4 9fd8a32a-034f-4784-ba22-700062d9973f Article (Published version) Public Article_scientifique_from_unpaywall.pdf 304221 application/pdf 96bf39683c0571a02e7d29509619209a4c18d16061aac3eec9e3fd48bb3e5bfc openAccess Faculté de médecine / Section de médecine clinique / Département de médecine

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Predicting deep venous thrombosis in pregnancy : external validation of the LEFT clinical prediction rule	Haematologica			2013	68	366

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Cirafici, Paul