Key result
Correct use of VTE clinical prediction rules is linked to ~54% lower diagnostic failure.
Why the study?
The real-life impact of clinical prediction rules for suspected venous thromboembolism in primary care was unknown despite evidence from controlled settings.
Cross-Sectional (n=1,477)
Yes
Correct application of VTE prediction rules was associated with lower failure and higher efficiency; leaves open whether interventions can improve adherence in primary care.
OBJECTIVE: Clinical 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. DESIGN: Cross-sectional cohort study. SETTING: Primary care in the Netherlands. PARTICIPANTS: Patients with suspected deep venous thrombosis (n=993) and suspected pulmonary embolism (n=484). INTERVENTIONS: General 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 MEASURES: application of the CPRs. RESULTS: In 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). CONCLUSIONS: Correct 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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Maanen et al. (2020) conducted a cross-sectional in Suspected venous thromboembolism (DVT or PE) (n=1,477). Correct application of clinical prediction rules (CPRs) vs. Incorrect application of CPRs was evaluated on Diagnostic failure rate (missed VTE in non-referred patients). Correct application of clinical prediction rules for suspected venous thromboembolism yielded a 1.51% failure rate and 58.1% efficiency, compared to 3.31% and 35.7% when incorrectly applied.
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