ArticleBMJ open2020
Real-life impact of clinical prediction rules for venous thromboembolism in primary care: a cross-sectional cohort study.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 8 citations in OpenAlex.
- Impact of a diagnostic strategy for appendicitis in children with acute abdominal pain in primary care: study protocol for a hybrid type 1 cluster randomised controlled trial.Diagnostic and prognostic research · 2026Review
- Perioperative anticoagulation reduces the incidence of venous thromboembolism in patients undergoing gastrointestinal surgery.World journal of gastrointestinal surgery · 2025Article
- YEARS clinical decision rule for diagnosing pulmonary embolism: a prospective diagnostic cohort follow-up study in primary care.BMJ open · 2025Article
- Clinical decision rules in primary care: necessary investments for sustainable healthcare.Primary health care research & development · 2023Article
- Two point-of-care test-based approaches for the exclusion of deep vein thrombosis in general practice: a cost-effectiveness analysis.BMC primary care · 2023Article
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveClinical prediction rules (CPRs) followed by D-dimer testing were shown to safely rule out venous thromboembolism (VTE) in about half of all suspected patients in controlled and experienced study settings. Yet, its real-life impact in primary care is unknown. The aim of this study was to determine the real-life impact of CPRs for suspected VTE in primary care.
designCross-sectional cohort study.
settingPrimary care in the Netherlands.
participantsPatients with suspected deep venous thrombosis (n=993) and suspected pulmonary embolism (n=484).
interventionsGeneral practitioners received an educational instruction on how to use CPRs in suspected VTE. We did not rectify incorrect application of the CPR in order to mimic daily clinical care.
main outcome measuresPrimary outcomes were the diagnostic failure rate, defined as the 3-month incidence of VTE in the non-referred group, and the efficiency, defined as the proportion of non-referred patients in the total study population. Secondary outcomes were determinants for and consequences of
resultsIn 267 of the included 1477 patients, VTE was confirmed. When CPRs were correctly applied, the failure rate was 1.51% (95% CI 0.77 to 2.86), and the efficiency was 58.1% (95% CI 55.2 to 61.0). However, the CPRs were incorrectly applied in 339 patients, which resulted in an increased failure rate of 3.31% (95% CI 1.07 to 8.76) and a decreased efficiency of 35.7% (95% CI 30.6 to 41.1). The presence of concurrent heart failure increased the likelihood of incorrect application (adjusted OR 3.26; 95% CI 1.47 to 7.21).
conclusionsCorrect application of CPRs for VTE in primary care is associated with an acceptable low failure rate at a high efficiency. Importantly, in nearly a quarter of patients, the CPRs were incorrectly applied that resulted in a higher failure rate and a considerably lower efficiency.
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