SynthesisQJM : monthly journal of the Association of Physicians2006
How should we diagnose suspected deep-vein thrombosis?
Synthesis in QJM : monthly journal of the Association of Physicians, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Guideline
- The diagnostic performance of APC-PCI complex determination compared to D-dimer in the diagnosis of deep vein thrombosis.Journal of thrombosis and thrombolysis · 2010Trial
- Pediatric emergency department point-of-care ultrasound diagnosis of unprovoked iliofemoral deep vein thrombosis in an adolescent: A case report.Radiology case reports · 2026Article
- Non-invasive diagnosis of deep vein thrombosis from ultrasound imaging with machine learning.NPJ digital medicine · 2021Article
- A systematic review of the cost-effectiveness of ultrasound in emergency care settings.The ultrasound journal · 2021Review
- Evaluation of Expression Level of Apolipoprotein M as a Diagnostic Marker for Primary Venous Thromboembolism.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis · 2018Article
- Article
- Evaluating the Use of a Negative D-Dimer and Modified Low Wells Score in Excluding above Knee Deep Venous Thrombosis in an Outpatient Population, Assessing Need for Diagnostic Ultrasound.ISRN radiology · 2014Article
- Systemic levels of the endothelium-derived soluble adhesion molecules endocan and E-selectin in patients with suspected deep vein thrombosis.SpringerPlus · 2014Article
- Evidence for treatment of muscular vein thrombosis in orthopaedic patients.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2013Review
- Deep venous thromboembolism after a trauma in a football player double heterozygous for factor V Leiden and prothrombin G20210A mutation: The role of genetic testing in sport.Journal of cardiology cases · 2012Article
- Thromboprophylaxis following major skeletal trauma: a systematic review.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2011Article
- Is it DVT? Wells score and D-dimer may avert costly workup.The Journal of family practice · 2007Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMany different approaches are used to diagnose suspected deep-vein thrombosis (DVT), but there has been little formal comparison of strategies.
aimTo identify the most cost-effective strategy for the UK National Health Service (NHS).
designSystematic review, meta-analysis and cost-effectiveness analysis.
methodsWe identified 18 strategies and estimated the diagnostic performance of constituent tests by systematic review and meta-analysis. Outcomes of testing and treatment were estimated from published data or by an expert panel. Costs were estimated from NHS reference costs and published data. We built a decision-analysis model to estimate, for each strategy, the overall accuracy, costs, and outcomes (valued as quality-adjusted life-years, QALYs), compared to a 'no testing, no treatment' alternative. Probabilistic analysis estimated the net benefit of each strategy at varying thresholds for willingness to pay for health gain.
resultsAt the thresholds for willingness to pay recommended by the National Institute for Clinical Excellence (20,000 pounds sterling-30,000 pounds sterling per QALY), the optimal strategy was to discharge patients with a low or intermediate Wells score and negative D-dimer, limiting ultrasound to those with a high score or positive D-dimer. Strategies using radiological testing for all patients were only cost-effective at 40,000 pound sterling per QALY or more. DISCUSSION: The optimal strategy for DVT diagnosis is to use ultrasound selectively in patients with a high clinical risk or positive D-dimer. Radiological testing for all patients does not appear to be a cost-effective use of health service resources.
Indexed as
Identifiers
16728440What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.