{"id":654,"date":"2011-02-16T09:17:40","date_gmt":"2011-02-16T00:17:40","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=654"},"modified":"2015-08-07T10:23:16","modified_gmt":"2015-08-07T01:23:16","slug":"%e3%83%97%e3%83%a9%e3%82%a4%e3%83%9e%e3%83%aa%e3%83%bb%e3%82%b1%e3%82%a2%e3%82%bb%e3%83%83%e3%83%86%e3%82%a3%e3%83%b3%e3%82%b0%e3%81%ab%e3%81%8a%e3%81%91%e3%82%8b%ef%bc%92%e3%81%a4%e3%81%aedvt","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=654","title":{"rendered":"\u30d7\u30e9\u30a4\u30de\u30ea\u30fb\u30b1\u30a2\u30bb\u30c3\u30c6\u30a3\u30f3\u30b0\u306b\u304a\u3051\u308b\uff12\u3064\u306eDVT\u8a3a\u65ad\u30eb\u30fc\u30eb\u306e\u6bd4\u8f03 \uff5e\u7cbe\u5ea6\u3068\u30b3\u30b9\u30c8\uff5e"},"content":{"rendered":"

\u3010\u6587\u732e\u540d\u3011
\n\u2028Comparing the Diagnostic Performance of 2 Clinical Decision Rules to Rule Out Deep Vein Thrombosis in Primary Care Patients. Eit Frits van der Velde, Diane B. Toll, Arina J. ten Cate-Hoek, et al.\u00a0 Ann Fam Med 2011;9:31-36\u2028\u2028\u2028\u2028<\/p>\n

\u3010\u8981\u7d04\u3011
\n\u3010Background knowledge\u3011
\n\u20281.The Wells rule has 10 items including one ‘subjective’ item: Alternative diagnosis at least as likely as DVT(or, Wells rule is influenced by pretest estimate of the clinician) \u2028If score is more than 1, ultrasound is indicated regardless of the result of D-dimer testing. \u2028If score is 0 or 1, ultrasound is indicated if D-dimer test is positive.
\n2.The primary care rule has 7 items(with no ‘subjective’ items) and D-dimer testing. \u2028If the score is more than 3, ultrasound is indicated. \u2028If the score is 3 or less, ultrasound is indicated if D-dimer test is positive.<\/p>\n

\u3010Purpose\u3011
\n\u2028The objective was to compare the Well’ rule (Table1) and the primary care rule (Table2).\u20281.The ability of both rules to safely rule out DVT\u20282.The ability of both rules to efficiently reduce the number of referrals for leg ultrasound investigation that would result in a negative finding.<\/p>\n

\u3010Methods\u3011
\n\u2028A.Study design; Prospective cohort study without control group.\u2028
\nB.Procedures
\n\u20281. Family physicians collected data on 1,086 patients to calculate the scores for both decision rules before leg ultrasonography was performed. Patients with 1 or more of the following symptoms were enrolled: swelling, redness, or pain of the lower extremity.\u2028
\n2. In all patients D-dimer (dimerized plasmin fragment D) testing was performed using a rapid point-of-care assay. URL;http:\/\/www.clearview.com\/d-dimer.aspx\u2028
\n3. Patients were stratified into risk categories defined by each rule and the D-dimer result. The actual management was based on the primary care rule as calculated by the attending physician.(Thus, the Wells rule score was only calculated in each patient and not considered in the management.)\u2028
\n4. Outcomes were DVT (diagnosed by ultrasonography) and venous thromboembolic complications or death caused by a possible thromboembolic event during a 90-day follow-up period. We calculated the differences\u2028between the 2 rules in the number of missed diagnoses and the proportions of patients that needed ultrasound testing.<\/p>\n

\u3010Results\u3011
\n\u2028A.Overall prevalence;
\n\u2028Data from 1,002 eligible patients were used for this analysis. Of 1,002 patients, 136 (14%) had DVT confirmed by objective testing. Three patients were lost to follow-up.
\n\u2028B.Outcome; Missed diagnosis;
\n\u2028A venous thromboembolic event occurred during follow-up in 7 patients with a low score and negative D-dimer finding, both with the Wells rule (7 of 447; 1.6%; 95% confidence interval [CI], 0.7%-3.3% ) and the primary care rule (7 of 495; 1.4%;95% CI, 0.6%-3.0%).
\n\u2028C.Outcome; The effectiveness of the rules(=The number of D-dimer testing and ultrasound);\u2028Using the Wells rule, 447 patients (45%) would not need referral for further testing compared with 495 patients (49%) when using the primary care rule (McNemar P <.001). (Fig.1 in detail.)\u2028\u00a0Fewer patients (22%) need D-dimer testing when using the Wells rule, but 4% more will have to be referred for compression ultrasonography.\u2028Expressed differently, to save 1 referral for compression ultrasonography, an additional 5 or 6 D-dimer tests have to be performed when using the primary care rule.\u2028\u2028\u2028\u2028\n\n\u3010\u8003\u5bdf\u3068\u30c7\u30a3\u30b9\u30ab\u30c3\u30b7\u30e7\u30f3\u3011\n\u8457\u8005\u304c\u305d\u308c\u305e\u308c\u306e\u30eb\u30fc\u30eb\u306b\u3064\u3044\u3066\u30b3\u30b9\u30c8\u3092\u8a08\u7b97\u3057\u3066\u3044\u308b\u3002\u2028\u30d7\u30e9\u30a4\u30de\u30ea\u30fb\u30b1\u30a2\u533b\u304cDVT\u3092\u7591\u3046\u60a3\u8005\u3092\uff11\uff10\uff10\u4eba\u8a3a\u7642\u3057\u305f\u3068\u304d\u2028\n\uff08\uff11\uff09\u00a0\u00a0\u00a0 \u30d7\u30e9\u30a4\u30de\u30ea\u30fb\u30b1\u30a2\u30eb\u30fc\u30eb\u3092\u9069\u7528\u3057\u305f\u5834\u5408\u3001D\u30c0\u30a4\u30de\u30fc\u306e\u30aa\u30fc\u30c0\u30fc\u304c22\u4ef6\u5897\u3048\u3001\uff04220\u306e\u30b3\u30b9\u30c8\u304c\u304b\u304b\u308b\uff08\uff11\u56de\u3042\u305f\u308a\uff0410\u3002\uff09\u2028\n\uff08\uff12\uff09\u00a0\u00a0\u00a0 Wells\u30eb\u30fc\u30eb\u3092\u9069\u7528\u3057\u305f\u5834\u5408\u3001\u8d85\u97f3\u6ce2\u30a8\u30b3\u30fc\u3078\u306e\u60a3\u8005\u7d39\u4ecb\u304c\uff14\u4ef6\u5897\u3048\u3001\uff04240\u306e\u30b3\u30b9\u30c8\u304c\u304b\u304b\u308b\uff08\uff11\u56de\u3042\u305f\u308a\uff0460\u3002\uff09\u2028DVT\u306b\u5bfe\u3059\u308b\u30d7\u30e9\u30a4\u30de\u30ea\u30fb\u30b1\u30a2\u30eb\u30fc\u30eb\u304c\u5b58\u5728\u3059\u308b\u3053\u3068\u3068\u305d\u306e\u6709\u7528\u6027\u3092\u77e5\u3063\u305f\u3002\u2028Wells\u30eb\u30fc\u30eb\u3082\u30d7\u30e9\u30a4\u30de\u30ea\u30fb\u30b1\u30a2\u30eb\u30fc\u30eb\u3068\u540c\u69d8\u306b\u6709\u7528\u3067\u3042\u308b\u304c\u3001\u8d85\u97f3\u6ce2\u30a8\u30b3\u30fc\u3078\u306e\u7d39\u4ecb\u4ef6\u6570\u304c\u5897\u3048\u308b\uff08\u90e1\u90e8\u3067\u306f\u3053\u306e\u3053\u3068\u304c\u969c\u58c1\u3068\u306a\u308a\u3046\u308b\uff09\u3002\u2028\n\u82f1\u56fd\u3067\u306fD\u30c0\u30a4\u30de\u30fc\u306e\u8fc5\u901f\u691c\u67fb\u304c\u666e\u53ca\u3057\u3066\u3044\u308b\u3053\u3068\u306b\u9a5a\u3044\u305f\u3002\n\n\"110216_1\"<\/a><\/p>\n

\"110216_2\"<\/a><\/p>\n

\"110216_3\"<\/a><\/p>\n

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\u3010\u6587\u732e\u540d\u3011 \u2028Comparing the Diagnostic Performance of 2 Clinical Decision Rules to Rule Out Deep Vein Thrombosis in P … \u7d9a\u304d\u3092\u8aad\u3080 \u30d7\u30e9\u30a4\u30de\u30ea\u30fb\u30b1\u30a2\u30bb\u30c3\u30c6\u30a3\u30f3\u30b0\u306b\u304a\u3051\u308b\uff12\u3064\u306eDVT\u8a3a\u65ad\u30eb\u30fc\u30eb\u306e\u6bd4\u8f03 \uff5e\u7cbe\u5ea6\u3068\u30b3\u30b9\u30c8\uff5e<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17],"tags":[],"class_list":["post-654","post","type-post","status-publish","format-standard","hentry","category-17"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/654","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=654"}],"version-history":[{"count":2,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/654\/revisions"}],"predecessor-version":[{"id":659,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/654\/revisions\/659"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=654"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=654"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=654"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}