Diagnosis of Lower Limb Deep Venous Thrombosis in Emergency Department Patients: Performance of Hamilton and Modified Wells Scores

Rathan M. Subramaniam, Brad Snyder, Rebekah Heath, Fiona Tawse, Jamie Sleigh

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Study objective: We validate and compare the Hamilton score for assessment of lower limb deep venous thrombosis with the modified Wells score. Methods: Consecutive patients presenting to the emergency department of a tertiary center for suspected lower limb deep venous thrombosis were prospectively recruited. Hamilton score and modified Wells score calculations, D-dimer, and complete (calf veins included), single lower limb ultrasonographic examination were performed for all patients. All patients with a negative ultrasonographic examination result for deep venous thrombosis were followed up for 3 months. Results: The study population consisted of 116 men and 193 women, with an average age of 55.6 years (SD 20.1). A total of 67 (21.7%) patients were diagnosed with deep venous thrombosis. Forty (59.7%) of these patients had isolated calf deep venous thrombosis, and the other 27 (40.3%) patients had proximal deep venous thrombosis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) for an unlikely Hamilton score (score ≤2) and D-dimer were 99% (95% confidence interval [CI] 92% to 99.96%), 42 % (95% CI 36% to 49%), 32% (95% CI 26% to 39%), 99% (95% CI 95% to 99.98%), 1.7 (95% CI 1.52% to 1.9%), and 0.04 (95% CI 0.01 to 0.25), respectively. The sensitivity, specificity, PPV, NPV, LR+ and LR- for an unlikely modified Wells score (score ≤1) and D-dimer were 99% (95% CI 92% to 99.96%), 33 % (95% CI 27% to 39%), 29% (95% CI 23% to 35%), 99% (95% CI 93% to 99.97%), 1.47 (95% CI 1.34 to 1.62), and 0.05 (95% CI 0.01 to 0.32), respectively. Conclusion: An unlikely probability of Hamilton score and a negative D-dimer may effectively exclude a lower limb deep venous thrombosis. Hamilton and modified Wells scores have similar performance characteristics.

Original languageEnglish (US)
Pages (from-to)678-685
Number of pages8
JournalAnnals of Emergency Medicine
Volume48
Issue number6
DOIs
StatePublished - Dec 1 2006

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Venous Thrombosis
Hospital Emergency Service
Lower Extremity
Confidence Intervals
Sensitivity and Specificity
Veins
fibrin fragment D

ASJC Scopus subject areas

  • Emergency Medicine

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Diagnosis of Lower Limb Deep Venous Thrombosis in Emergency Department Patients : Performance of Hamilton and Modified Wells Scores. / Subramaniam, Rathan M.; Snyder, Brad; Heath, Rebekah; Tawse, Fiona; Sleigh, Jamie.

In: Annals of Emergency Medicine, Vol. 48, No. 6, 01.12.2006, p. 678-685.

Research output: Contribution to journalArticle

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abstract = "Study objective: We validate and compare the Hamilton score for assessment of lower limb deep venous thrombosis with the modified Wells score. Methods: Consecutive patients presenting to the emergency department of a tertiary center for suspected lower limb deep venous thrombosis were prospectively recruited. Hamilton score and modified Wells score calculations, D-dimer, and complete (calf veins included), single lower limb ultrasonographic examination were performed for all patients. All patients with a negative ultrasonographic examination result for deep venous thrombosis were followed up for 3 months. Results: The study population consisted of 116 men and 193 women, with an average age of 55.6 years (SD 20.1). A total of 67 (21.7{\%}) patients were diagnosed with deep venous thrombosis. Forty (59.7{\%}) of these patients had isolated calf deep venous thrombosis, and the other 27 (40.3{\%}) patients had proximal deep venous thrombosis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) for an unlikely Hamilton score (score ≤2) and D-dimer were 99{\%} (95{\%} confidence interval [CI] 92{\%} to 99.96{\%}), 42 {\%} (95{\%} CI 36{\%} to 49{\%}), 32{\%} (95{\%} CI 26{\%} to 39{\%}), 99{\%} (95{\%} CI 95{\%} to 99.98{\%}), 1.7 (95{\%} CI 1.52{\%} to 1.9{\%}), and 0.04 (95{\%} CI 0.01 to 0.25), respectively. The sensitivity, specificity, PPV, NPV, LR+ and LR- for an unlikely modified Wells score (score ≤1) and D-dimer were 99{\%} (95{\%} CI 92{\%} to 99.96{\%}), 33 {\%} (95{\%} CI 27{\%} to 39{\%}), 29{\%} (95{\%} CI 23{\%} to 35{\%}), 99{\%} (95{\%} CI 93{\%} to 99.97{\%}), 1.47 (95{\%} CI 1.34 to 1.62), and 0.05 (95{\%} CI 0.01 to 0.32), respectively. Conclusion: An unlikely probability of Hamilton score and a negative D-dimer may effectively exclude a lower limb deep venous thrombosis. Hamilton and modified Wells scores have similar performance characteristics.",
author = "Subramaniam, {Rathan M.} and Brad Snyder and Rebekah Heath and Fiona Tawse and Jamie Sleigh",
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T1 - Diagnosis of Lower Limb Deep Venous Thrombosis in Emergency Department Patients

T2 - Performance of Hamilton and Modified Wells Scores

AU - Subramaniam, Rathan M.

AU - Snyder, Brad

AU - Heath, Rebekah

AU - Tawse, Fiona

AU - Sleigh, Jamie

PY - 2006/12/1

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N2 - Study objective: We validate and compare the Hamilton score for assessment of lower limb deep venous thrombosis with the modified Wells score. Methods: Consecutive patients presenting to the emergency department of a tertiary center for suspected lower limb deep venous thrombosis were prospectively recruited. Hamilton score and modified Wells score calculations, D-dimer, and complete (calf veins included), single lower limb ultrasonographic examination were performed for all patients. All patients with a negative ultrasonographic examination result for deep venous thrombosis were followed up for 3 months. Results: The study population consisted of 116 men and 193 women, with an average age of 55.6 years (SD 20.1). A total of 67 (21.7%) patients were diagnosed with deep venous thrombosis. Forty (59.7%) of these patients had isolated calf deep venous thrombosis, and the other 27 (40.3%) patients had proximal deep venous thrombosis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) for an unlikely Hamilton score (score ≤2) and D-dimer were 99% (95% confidence interval [CI] 92% to 99.96%), 42 % (95% CI 36% to 49%), 32% (95% CI 26% to 39%), 99% (95% CI 95% to 99.98%), 1.7 (95% CI 1.52% to 1.9%), and 0.04 (95% CI 0.01 to 0.25), respectively. The sensitivity, specificity, PPV, NPV, LR+ and LR- for an unlikely modified Wells score (score ≤1) and D-dimer were 99% (95% CI 92% to 99.96%), 33 % (95% CI 27% to 39%), 29% (95% CI 23% to 35%), 99% (95% CI 93% to 99.97%), 1.47 (95% CI 1.34 to 1.62), and 0.05 (95% CI 0.01 to 0.32), respectively. Conclusion: An unlikely probability of Hamilton score and a negative D-dimer may effectively exclude a lower limb deep venous thrombosis. Hamilton and modified Wells scores have similar performance characteristics.

AB - Study objective: We validate and compare the Hamilton score for assessment of lower limb deep venous thrombosis with the modified Wells score. Methods: Consecutive patients presenting to the emergency department of a tertiary center for suspected lower limb deep venous thrombosis were prospectively recruited. Hamilton score and modified Wells score calculations, D-dimer, and complete (calf veins included), single lower limb ultrasonographic examination were performed for all patients. All patients with a negative ultrasonographic examination result for deep venous thrombosis were followed up for 3 months. Results: The study population consisted of 116 men and 193 women, with an average age of 55.6 years (SD 20.1). A total of 67 (21.7%) patients were diagnosed with deep venous thrombosis. Forty (59.7%) of these patients had isolated calf deep venous thrombosis, and the other 27 (40.3%) patients had proximal deep venous thrombosis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) for an unlikely Hamilton score (score ≤2) and D-dimer were 99% (95% confidence interval [CI] 92% to 99.96%), 42 % (95% CI 36% to 49%), 32% (95% CI 26% to 39%), 99% (95% CI 95% to 99.98%), 1.7 (95% CI 1.52% to 1.9%), and 0.04 (95% CI 0.01 to 0.25), respectively. The sensitivity, specificity, PPV, NPV, LR+ and LR- for an unlikely modified Wells score (score ≤1) and D-dimer were 99% (95% CI 92% to 99.96%), 33 % (95% CI 27% to 39%), 29% (95% CI 23% to 35%), 99% (95% CI 93% to 99.97%), 1.47 (95% CI 1.34 to 1.62), and 0.05 (95% CI 0.01 to 0.32), respectively. Conclusion: An unlikely probability of Hamilton score and a negative D-dimer may effectively exclude a lower limb deep venous thrombosis. Hamilton and modified Wells scores have similar performance characteristics.

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