Clinical utility of the modified Wells score in combination with the D-dimer assay in the prediction of deep venous thrombosis in a local population
Date
2013-01-25
Authors
Goodier, Matthew
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Abstract
Clinical prediction scores such as the modified Wells score have proved useful to determine the likelihood for the presence of lower limb deep venous thrombosis (DVT). Infection with HIV may affect the validity of this approach in the South African context. This study of 230, mostly inpatients, of which 40% were HIV positive, confirms the validity of the modified Wells score in a South African population with a high HIV seroprevalence. The score was found to be most accurate when performed within 48 hours of initiation of anticoagulation therapy and when combined with D-dimer assay result. The more widespread utilisation of this score, especially in conjunction with the D-dimer assay as part of a diagnostic algorithm will make investigation of DVT simpler and more cost effective. A diagnostic algorithm previously proven to be cost effective is suggested for adoption in local clinical practice as well as a basis for future research.