Expanded Criteria for the Diagnosis of Deep Venous Thrombosis

Over five years, we examined 1,698 patients for suspected deep venous thrombosis (DVT), using the pulse volume recorder (PVR) combined with Doppler ultrasonography. We report the 244 patients who subsequently underwent venography. Fifty-three (50%) of 106 patients with true-positive study results by venography had derived PVR-Doppler total venous scores (TVSs) of 4 or less, the accepted standard for a "normal" result. Had those TVSs alone been used to rule out DVT, all 53 patients would have had false-negative study results (sensitivity, 44%). Thus, total reliance on a TVS of 4 or less to exclude the diagnosis of DVT is inadequate. By using five "expanded criteria," we increased the test sensitivity to 90%. Thus, when a TVS of 4 or less is found, the presence of any of the expanded criteria mandates further examination to exclude DVT.