Journal articles: 'Wells-Score'

1

Abdelaal Ahmed Mahmoud M. Alkhatip, Ahmed, Maria Donnelly, Lindi Snyman, Patrick Conroy, Mohamed Khaled Hamza, Ian Murphy, Andrew Purcell, and David McGuire. "YEARS Algorithm Versus Wells’ Score." Critical Care Medicine 48, no. 5 (May 2020): 704–8. http://dx.doi.org/10.1097/ccm.0000000000004271.

Full text

APA, Harvard, Vancouver, ISO, and other styles

2

Abdel Kerim, Yasser. "AKT question relating to Wells score." InnovAiT: Education and inspiration for general practice 13, no. 6 (May 15, 2020): 343. http://dx.doi.org/10.1177/1755738020913216.

Full text

APA, Harvard, Vancouver, ISO, and other styles

3

Hasanoğlu, Canan, Emine Argüder, Hatice Kılıç, Ebru Sengul Parlak, and Ayşegül Karalezli. "Atrial fibrillation, an obscured cause of pulmonary embolism can be revealed by adding to Wells criteria." Journal of Investigative Medicine 67, no. 7 (May 7, 2019): 1042–47. http://dx.doi.org/10.1136/jim-2018-000914.

Full text

Abstract:

Among the various clinical scoring methods used for the prediagnosis of pulmonary embolism (PE), Wells criteria is the most common. It relies on the findings and story of deep venous thrombosis (DVT), PE and malignancy. It is known that atrial fibrillation (AF) is a risk factor for PE like as DVT or malignancy. We aimed to evaluate the possibility of diagnosing more patients with PE by including AF in the Wells criteria. This prospective study included 250 patients admitted to the emergency department with PE findings. Wells scoring and Wells scoring with AF were performed for each patient. Out of 250 patients, 165 patients were diagnosed as PE. Wells score was >4 in 61.8% of patients with PE and 28.2% of patients without PE. Out of false negative 63 patients with PE, 21 of them had AF. According to Wells scoring with AF the score of 148 (89.7%) patients with PE diagnosis was ≥3, whereas the score of 45 (52.9%) patients without PE was ≥3. AF was detected in 15.8% of patients with PE. The sensitivity of Wells score with AF was significantly higher than that of the Wells score (p<0.001). As a result, when AF, which is one of an important PE cause such as DVT and malignancy, was added to the Wells criteria, an additional correct PE estimate was obtained in 46 patients. We recommend using Wells score with AF since prediagnosing more PE is more valuable than having some false negative PE predictions.

APA, Harvard, Vancouver, ISO, and other styles

4

Price, Erika Leemann, and Tracy Minichiello. "The Wells Deep Vein Thrombosis Score for Inpatients." JAMA Internal Medicine 175, no. 7 (July 1, 2015): 1118. http://dx.doi.org/10.1001/jamainternmed.2015.1699.

Full text

APA, Harvard, Vancouver, ISO, and other styles

5

Pommer, P. "Tiefe Beinvenenthrombose: Wells-Score zum Ausschluss meist geeignet." DMW - Deutsche Medizinische Wochenschrift 139, no. 18 (April 23, 2014): 926. http://dx.doi.org/10.1055/s-0034-1372256.

Full text

APA, Harvard, Vancouver, ISO, and other styles

6

Girardi, Adriana M., Renata S. Bettiol, Tiago S. Garcia, Gustavo L. H. Ribeiro, Édison Moraes Rodrigues, Marcelo B. Gazzana, and Tatiana H. Rech. "Wells and Geneva Scores Are Not Reliable Predictors of Pulmonary Embolism in Critically Ill Patients: A Retrospective Study." Journal of Intensive Care Medicine 35, no. 10 (December 16, 2018): 1112–17. http://dx.doi.org/10.1177/0885066618816280.

Full text

Abstract:

Background: Critically ill patients are at high risk for pulmonary embolism (PE). Specific PE prediction rules have not been validated in this population. The present study assessed the Wells and revised Geneva scoring systems as predictors of PE in critically ill patients. Methods: Pulmonary computed tomographic angiograms (CTAs) performed for suspected PE in critically ill adult patients were retrospectively identified. Wells and revised Geneva scores were calculated based on information from medical records. The reliability of both scores as predictors of PE was determined using receiver operating characteristic (ROC) curve analysis. Results: Of 138 patients, 42 (30.4%) were positive for PE based on pulmonary CTA. Mean Wells score was 4.3 (3.5) in patients with PE versus 2.7 (1.9) in patients without PE ( P < .001). Revised Geneva score was 5.8 (3.3) versus 5.1 (2.5) in patients with versus without PE ( P = .194). According to the Wells and revised Geneva scores, 56 (40.6%) patients and 49 (35.5%) patients, respectively, were considered as low probability for PE. Of those considered as low risk by the Wells score, 15 (26.8%) had filling defects on CTA, including 2 patients with main pulmonary artery embolism. The area under the ROC curve was 0.634 for the Wells score and 0.546 for the revised Geneva score. Wells score >4 had a sensitivity of 40%, specificity of 87%, positive predictive value of 59%, and negative predictive value of 77% to predict risk of PE. Conclusions: In this population of critically ill patients, Wells and revised Geneva scores were not reliable predictors of PE.

APA, Harvard, Vancouver, ISO, and other styles

7

Sermsathanasawadi, N., P. Suparatchatpun, T. Pumpuang, K. Hongku, K. Chinsakchai, C. Wongwanit, C. Ruangsetakit, and P. Mutirangura. "Comparison of clinical prediction scores for the diagnosis of deep vein thrombosis in unselected population of outpatients and inpatients." Phlebology: The Journal of Venous Disease 30, no. 7 (June 25, 2014): 469–74. http://dx.doi.org/10.1177/0268355514541981.

Full text

Abstract:

Objectives The aim of this research was to compare the accuracy of the modified Wells, the Wells, the Kahn, the St. André, and the Constans score for the diagnosis of deep vein thrombosis of the lower limb in unselected population of outpatients and inpatients. Method The pretest of probability score was employed in consecutive 500 outpatients and inpatients with suspicion of deep vein thrombosis. All patients were examined with compression ultrasonography. Results Deep vein thrombosis was confirmed in 26.4%. In the unselected population of outpatients and inpatients, the accuracy of the modified Wells score and the Constans score was higher than other scores. Both scores were more accurate for the outpatients. There was no accurate score for the inpatient subgroup. Conclusions The modified Wells and the Constans score appear to be useful in the unselected population of outpatients and inpatients and particularly in the outpatient subgroup.

APA, Harvard, Vancouver, ISO, and other styles

8

Palanisamy, Dhanaraj, and Akshay Omkumar. "A study on the effectiveness of wells criteria for diagnosing deep vein thrombosis: a prospective observational study." International Surgery Journal 8, no. 2 (January 29, 2021): 569. http://dx.doi.org/10.18203/2349-2902.isj20210365.

Full text

Abstract:

Background: Wells score which takes into account various aspects in the history as well as various clinical signs which can help the clinician to arrive at a diagnosis of deep vein thrombosis (DVT). This helps to save time and money that is wasted in doing many unnecessary investigations. Aim of the study was to test the application of the Wells score in our clinical set up and to see how effectively we can diagnose DVT.Methods: This was a prospective diagnostic validation study of the wells rule for DVT in our setup, ultrasound (USG) being the gold standard comparison and will be conducted over a duration of 12 months. Wells score for each patient was calculated and the results were evaluated.Results: Among the 50 cases suspected DVT, the wells score was able to predict DVT in 46 of the cases thus proving to be a very efficient diagnostic indicator. The average wells score among the various cases was 4/8. Complications noted in the study group were 2 cases of cortical vein thrombosis in the post-partum period which fully recovered. Mortality rate in the study group was 4.3% in which a single case of diagnosed myocardial infarction died of heart failure.Conclusions: Wells score is indeed a very good predictive criteria for DVT and can be applied with ease as it required only clinical assessment and thus avoids unnecessary delays in waiting for scans thereby allowing us to start anticoagulants as early as possible.

APA, Harvard, Vancouver, ISO, and other styles

9

Rahiminejad, Maryam, Anshul Rastogi, Shirish Prabhudesai, David Mcclinton, Peter MacCallum, Sean Platton, and Emma Friedman. "Evaluating the Use of a Negative D-Dimer and Modified Low Wells Score in Excluding above Knee Deep Venous Thrombosis in an Outpatient Population, Assessing Need for Diagnostic Ultrasound." ISRN Radiology 2014 (March 9, 2014): 1–5. http://dx.doi.org/10.1155/2014/519875.

Full text

Abstract:

Aims. Colour doppler ultrasonography (CDUS) is widely used in the diagnosis of deep venous thrombosis (DVT); however, the number of scans positive for above knee DVT is low. The present study evaluates the reliability of the D-dimer test combined with a clinical probability score (Wells score) in ruling out an above knee DVT and identifying patients who do not need a CDUS. Materials and Method. This study is a retrospective audit and reaudit of a total of 816 outpatients presenting with suspected lower limb DVT from March 2009 to March 2010 and from September 2011 to February 2012. Following the initial audit, a revised clinical diagnostic pathway was implemented. Results. In our initial audit, seven patients (4.9%) with a negative D-dimer and a low Wells score had a DVT. On review, all seven had a risk factor identified that was not included in the Wells score. No patient with negative D-dimer and low Wells score with no extra clinical risk factor had a DVT on CDUS (negative predictive value 100%). A reaudit confirmed adherence to our revised clinical diagnostic pathway. Conclusions. A negative D-dimer together with a low Wells score and no risk factors effectively excludes a lower limb DVT and an ultrasound is unnecessary in these patients.

APA, Harvard, Vancouver, ISO, and other styles

10

Bublak, Robert. "Mit Wells-Score und D-Dimer-Test Lungenembolien ausschließen." MMW - Fortschritte der Medizin 154, no. 19 (November 2012): 7. http://dx.doi.org/10.1007/s15006-012-1315-5.

Full text

APA, Harvard, Vancouver, ISO, and other styles

11

Trihan, Jean-Eudes, Michael Adam, Sara Jidal, Isabelle Aichoun, Sarah Coudray, Jeremy Laurent, Laurent Chaussavoine, et al. "Performance of the Wells score in predicting deep vein thrombosis in medical and surgical hospitalized patients with or without thromboprophylaxis: The R-WITT study." Vascular Medicine 26, no. 3 (March 22, 2021): 288–96. http://dx.doi.org/10.1177/1358863x21994672.

Full text

Abstract:

The Wells score had shown weak performance to determine pre-test probability of deep vein thrombosis (DVT) for inpatients. So, we evaluated the impact of thromboprophylaxis on the utility of the Wells score for risk stratification of inpatients with suspected DVT. This bicentric cross-sectional study from February 1, 2018 to January 31, 2019 included consecutive medical and surgical inpatients who underwent lower limb ultrasound study for suspected DVT. Wells score clinical predictors were assessed by both ordering and vascular physicians within 24 h after clinical suspicion of DVT. Primary outcome was the Wells score’s accuracy for pre-test risk stratification of suspected DVT, accounting for anticoagulation (AC) treatment (thromboprophylaxis for ⩾ 72 hours or long-term anticoagulation). We compared prevalence of proximal DVT among the low, moderate and high pre-test probability groups. The discrimination accuracy was defined as area under the receiver operating characteristics (ROC) curve. Of the 415 included patients, 30 (7.2%) had proximal DVT. Prevalence of proximal DVT was lower than expected in all pre-test probability groups. The prevalence in low, moderate and high pre-test probability groups was 0.0%, 3.1% and 8.2% ( p = 0.22) and 1.7%, 4.2% and 25.8% ( p < 0.001) for inpatients with or without AC, respectively. Area under ROC curves for discriminatory accuracy of the Wells score, for risk of proximal DVT with or without AC, was 0.72 and 0.88, respectively. The Wells score performed poorly for discrimination of risk for proximal DVT in hospitalized patients with AC but performed reasonably well among patients without AC; and showed low inter-rater reliability between physicians. ClinicalTrials.gov Identifier: NCT03784937.

APA, Harvard, Vancouver, ISO, and other styles

12

Djajakusumah, Teguh Marfen, Putie Hapsari, Daniel Marthin Situmorang, and Muhammad Faiz Ulurrosyad. "Comparison Between Wells’ Criteria and Khorana Score in Detecting Asymptomatic Deep Vein Thrombosis in Colorectal Cancer Patients in Dr. Hasan Sadikin Hospital." Journal of Indonesian Society for Vascular and Endovascular Surgery 2, no. 1 (January 21, 2021): 17–19. http://dx.doi.org/10.36864/jinasvs.2021.1.006.

Full text

Abstract:

Background: Deep vein thrombosis is a blood clot that occurs in the deep veins. Fifty percent of patients with deep vein thrombosis do not show clinical symptoms. The incidence of deep vein thrombosis in colorectal cancer patients is higher than in other cancer patients. Several scoring system models, such as Wells’ criteria and Khorana score, were developed to help diagnose deep vein thrombosis . Methods: This study was a prospective observational analytic with cross sectional design that compared the Khorana score with Wells’ criteria in predicting the occurrrence of asymptomatic deep vein thrombosis in colorectal cancer patients. Comparisons were made using Chi Square analytical test and diagnostic tests. Results: A total of 63 patients were obtained. Using Wells’ criteria, 55 patients (87.3%) fell into the mild risk category, 8 patients (12.7%) in the moderate risk category and no patients in the high risk category. Using Khorana score, 35 patients (55.6%) fell into the mild risk category, 28 (44.4%) patients in the moderate risk category, and no high risk category patients were found. There were 14 patients (22.2%) with asymptomatic deep vein thrombosis and 49 patients (77.8%) without deep vein thrombosis. Comparison of the proportion of Wells’ criteria with asymptomatic patients has a p-value of 0.48, while Khorana score with asymptomatic patients has a p-value of 0.001. Conclusion: Khorana score is better than Wells’ criteria in detecting asymptomatic deep vein thrombosis in colorectal cancer patients.

APA, Harvard, Vancouver, ISO, and other styles

13

Tenna, A. M. S., S. Kappadath, and G. Stansby. "Diagnostic tests and strategies in venous thromboembolism." Phlebology: The Journal of Venous Disease 27, no. 2_suppl (April 2012): 43–52. http://dx.doi.org/10.1258/phleb.2012.012s35.

Full text

Abstract:

Venous thromboembolism (VTE) is a term including deep vein thrombosis (DVT) and pulmonary embolism (PE). Timely and accurate diagnosis of both is essential as delayed or missed diagnoses can result in death or longer term complications. Patients with suspected DVT should initially undergo a pretest probability Wells score. Depending on pretest probability Wells score they should then either proceed to two-point ultrasound scanning or D-dimer testing. Likewise, patients suspected of PE should undergo a two-level PE Wells score, and, if scored likely, a computed tomography pulmonary angiogram (CTPA), or, if there is a low pretest probability score, D-dimer testing. If positive, patients should undergo CTPA. Ventilation perfusion scanning (V/Q scan) or V/Q SPECT should be considered in place of CTPA if there is allergy to contrast media or renal impairment.

APA, Harvard, Vancouver, ISO, and other styles

14

Ambid Lacombe, C., J. P. Cambou, H. Boccalon, and A. Bura Rivière. "Le score de Wells modifié ne prédit pas mieux la présence de thrombose veineuse profonde que le score de Wells dans sa version originale." Journal des Maladies Vasculaires 32 (September 2007): 61. http://dx.doi.org/10.1016/j.jmv.2007.06.052.

Full text

APA, Harvard, Vancouver, ISO, and other styles

15

Habibi Moghadam, Morteza, Marzieh Asadizaker, Simin Jahani, Elham Maraghi, Hakimeh Saadatifar, and Farhad Naanaei. "INVESTIGATING EFFECT OF NURSING INTERVENTIONS, BASED ON WELLS SCORE RESULTS, ON THE INCIDENCE OF DEEP VEIN THROMBOSIS IN PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT." Asian Journal of Pharmaceutical and Clinical Research 11, no. 5 (May 1, 2018): 377. http://dx.doi.org/10.22159/ajpcr.2018.v11i5.24939.

Full text

Abstract:

Objective: Venous thromboembolism, including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complaint in critically ill patients. Therefore, the present study was conducted to determine the effect of nursing interventions, based on the Wells results, on the incidence of DVT in intensive care unit (ICU) patients.Methods: The present clinical trial was conducted on 72 ICU patients without DVT and PE who met the inclusion criteria according to Wells score in Dr. Ganjavian Hospital, Dezful in 2012. The participants were investigated and randomly divided into intervention (n=36) and control groups (n=36). The intervention group received preventive nursing measures based on the risk level determined by the Wells score, and routine therapeutic interventions were performed for the control group. Then, patients were evaluated using Wells score, D-dimer testing, and Doppler sonography on the 1st, 5th, and 10th days. Data were finally coded and entered into SPSS version 23. Data analysis was performed using Chi-square, Fisher’s exact, and Mann–Whitney U tests.Results: The incidence of DVT in both groups showed that 2 patients of the control group who were identified to be at risk using the Wells score were diagnosed with DVT while none of the patients of the intervention group experienced DVT. The present study showed that 22.2% of the patients of the control group suffered from non-pitting edema, which was significantly different from the intervention group (p=0.005).Conclusion: The results of the present study showed that using the Wells score for early identification of the at-risk patients and nursing interventions based on this score’s results is helpful in the prevention of DVT. Appropriate nursing interventions were also effective in reducing the incidence of non-pitting edema in the lower extremities.

APA, Harvard, Vancouver, ISO, and other styles

16

Alqaydi, K., J. Turner, L. Robichaud, D. Hamad, X. Xue, and M. Afilalo. "P001: Age-adjusted D-dimer and two-site compression point of care ultrasonography to rule out acute deep vein thrombosis - a pilot study." CJEM 20, S1 (May 2018): S57. http://dx.doi.org/10.1017/cem.2018.199.

Full text

Abstract:

Introduction: Deep vein thrombosis (DVT) can lead to significant morbidity and mortality if not diagnosed and treated promptly. Currently, few methods aside from venous duplex scanning can rule out DVT in patients presenting to the Emergency Department (ED). Current screening tools, including the use of the subjective Wells score, frequently leads to unnecessary investigations and anticoagulation. In this study, we sought to determine whether two-site compression point-of-care ultrasound (POCUS) combined with a negative age-adjusted D-dimer test can accurately rule out DVT in ED patients irrespective of the modified Wells score. Methods: This is a single-center, prospective observational study in the ED of the Jewish General Hospital in Montreal. We are recruiting a convenience sample of patients presenting to the ED with symptoms suggestive of DVT. All enrolled patients are risk-stratified using the modified Wells criteria for DVT, then undergo two-site compression POCUS, and testing for age-adjusted D-dimer. Patients with DVT unlikely according to modified Wells score, negative POCUS and negative age-adjusted D-dimer are discharged home and receive a three-month phone follow-up. Patients with DVT likely according to modified Wells score, a positive POCUS or a positive age-adjusted D-dimer, will undergo a venous duplex scan. A true negative DVT is defined as either a negative venous duplex scan or a negative follow-up phone questionnaire for patients who were sent home without a venous duplex scan. Results: Of the 42 patients recruited thus far, the mean age is 56 years old and 42.8% are male. Twelve (28.6%) patients had DVT unlikely as per modified Wells score, negative POCUS and negative age-adjusted D-dimer and were discharged home. None of these patients developed a DVT on three-month follow-up. Thirty patients (71.4%) had either a DVT likely as per modified Wells score, a positive POCUS or a positive age-adjusted D-dimer and underwent a venous duplex scan. Of those, six patients had a confirmed DVT (3 proximal & 3 distal). POCUS detected all proximal DVTs, while combined POCUS and age-adjusted D-dimer detected all proximal and distal DVTs. None of the patients with a negative POCUS and age-adjusted D-dimer were found to have a DVT. Conclusion: Two-site compression POCUS combined with a negative age-adjusted D-dimer test appears to accurately rule out DVT in ED patients without the need for follow-up duplex venous scan. Using this approach would alleviate the need to calculate the Wells score, and also reduce the need for radiology-performed duplex venous scan for many patients.

APA, Harvard, Vancouver, ISO, and other styles

17

Zaid, Nehad Abdou, Mahmoud S. El Desoky, and Seham F. Attia. "Reducing ultrasound in diagnosing deep vein thrombosis by using clinical scores and D-dimer testing." International Surgery Journal 7, no. 2 (January 27, 2020): 332. http://dx.doi.org/10.18203/2349-2902.isj20200279.

Full text

Abstract:

Background: To reduce unnecessary venous ultrasound examination in cases suspected to have deep venous thrombosis (DVT) in emergency department by using D dimer and wells score. venous duplex is widely used to diagnose DVT increasing burden on ultrasound in overcrowded emergency department. Authors can decrease this burden by using clinical probability scores and D dimer.Methods: This is prospective study done on 50 consecutive patients suspected to have DVT represented to emergency department of Menoufia University Hospital during the period from June 2018 to June 2019. Full history, physical examination, assessment of clinical probability score, d dimer level and results of venous duplex collection.Results: According to wells score, the majority of cases diagnosed as DVT were of high probability group 13(68.4%), 5 patients with moderate probability and only one patient with low probability was diagnosed as DVT. The mean of D dimer level in cases diagnosed as DVT is (4173.6±2173.1) and in cases without DVT is (927.4±1064.6). Using wells score and D dimer together, sensitivity is 100%, Specificity is 94%. PPV is 90%, and NPV is 100% in predicting DVT. All cases with negative d dimer and low risk probability do not have DVT.Conclusions: Based on this result, using wells score and d dimer level in early work up of patients suspected to have DVT will decrease overusing and cost of venous duplex.

APA, Harvard, Vancouver, ISO, and other styles

18

Ngasala, Tula M., Susan J. Masten, Mantha S. Phanikumar, and Emiliana J. Mwita. "Analysis of water security and source preferences in rural Tanzania." Journal of Water, Sanitation and Hygiene for Development 8, no. 3 (April 20, 2018): 439–48. http://dx.doi.org/10.2166/washdev.2018.169.

Full text

Abstract:

Abstract The public health and well-being of people in many rural communities in developing countries suffer due to poor water resources management and undesirable agricultural practices. This study was conducted in a pastoral community in northern Tanzania. The objective was to identify the most reliable water source in terms of quality and access from three main water sources: surface water, shallow wells, and deep wells. The Water Quality Index (WQI) was used to assess the overall water quality and was determined to be 1,876, 875 and 157, respectively, for surface water, shallow wells, and deep wells (<50 – excellent, >300 – poor). A Water Poverty Index (WPI) tool was used to quantify five factors that limit access to water: (1) seasonal availability, (2) distance to water sources, (3) cost of purchasing water, (4) preference, and (5) water quality. WPI scores indicated that surface water has the highest score followed by shallow wells; deep wells had the lowest score. In conclusion, in terms of access and quantity, deep wells and shallow wells were the least reliable, and surface water although highly contaminated, is the most reliable. Improving water quality and access of existing water resources is critical to improving the well-being of rural populations.

APA, Harvard, Vancouver, ISO, and other styles

19

Katsios, CM, M. Donadini, M. Meade, S. Mehta, R. Hall, J. Granton, J. Kutsiogiannis, et al. "Prediction Scores Do Not Correlate with Clinically Adjudicated Categories of Pulmonary Embolism in Critically Ill Patients." Canadian Respiratory Journal 21, no. 1 (2014): 36–42. http://dx.doi.org/10.1155/2014/296161.

Full text

Abstract:

BACKGROUND: Prediction scores for pretest probability of pulmonary embolism (PE) validated in outpatient settings are occasionally used in the intensive care unit (ICU).OBJECTIVE: To evaluate the correlation of Geneva and Wells scores with adjudicated categories of PE in ICU patients.METHODS: In a randomized trial of thromboprophylaxis, patients with suspected PE were adjudicated as possible, probable or definite PE. Data were then retrospectively abstracted for the Geneva Diagnostic PE score, Wells, Modified Wells and Simplified Wells Diagnostic scores. The chance-corrected agreement between adjudicated categories and each score was calculated. ANOVA was used to compare values across the three adjudicated PE categories.RESULTS: Among 70 patients with suspected PE, agreement was poor between adjudicated categories and Geneva pretest probabilities (kappa 0.01 [95% CI −0.0643 to 0.0941]) or Wells pretest probabilities (kappa −0.03 [95% CI −0.1462 to 0.0914]). Among four possible, 16 probable and 50 definite PEs, there were no significant differences in Geneva scores (possible = 4.0, probable = 4.7, definite = 4.5; P=0.90), Wells scores (possible = 2.8, probable = 4.9, definite = 4.1; P=0.37), Modified Wells (possible = 2.0, probable = 3.4, definite = 2.9; P=0.34) or Simplified Wells (possible = 1.8, probable = 2.8, definite = 2.4; P=0.30).CONCLUSIONS: Pretest probability scores developed outside the ICU do not correlate with adjudicated PE categories in critically ill patients. Research is needed to develop prediction scores for this population.

APA, Harvard, Vancouver, ISO, and other styles

20

Young, Matthew D., Alan H. Daniels, Peter T. Evangelista, Steven E. Reinert, Scott Ritterman, Melissa A. Christino, Nikhil A. Thakur, and Christopher T. Born. "Predicting Pulmonary Embolus in Orthopedic Trauma Patients Using the Wells Score." Orthopedics 36, no. 5 (May 1, 2013): e642-e647. http://dx.doi.org/10.3928/01477447-20130426-29.

Full text

APA, Harvard, Vancouver, ISO, and other styles

21

Korevaar, Daniël A., Jérémie F. Cohen, and Josien van Es. "YEARS Algorithm Versus Wells’ Score: Incomplete Reporting Undermines Study Quality Assessment." Critical Care Medicine 48, no. 8 (August 2020): e730-e730. http://dx.doi.org/10.1097/ccm.0000000000004369.

Full text

APA, Harvard, Vancouver, ISO, and other styles

22

Rosa-Jiménez, F., A. Rosa-Jiménez, A. Lozano-Rodríguez, P. Martín-Moreno, M. D. Hinojosa-Martínez, and Á. M. Montijano-Cabrera. "Has the time come to search for the Wells score 4.0?" Revista Clínica Española (English Edition) 215, no. 5 (June 2015): 258–64. http://dx.doi.org/10.1016/j.rceng.2015.01.001.

Full text

APA, Harvard, Vancouver, ISO, and other styles

23

Khetpal, Reshma, and Muhammad H. Shibli. "Predictability of Wells Score for the Diagnosis of Acute Pulmonary Embolism." Chest 138, no. 4 (October 2010): 938A. http://dx.doi.org/10.1378/chest.10949.

Full text

APA, Harvard, Vancouver, ISO, and other styles

24

Krome, S. "Sicherer Ausschluss von Lungenarterienembolien durch Wells-Score und D-Dimer-Test." DMW - Deutsche Medizinische Wochenschrift 137, no. 48 (November 20, 2012): 2467. http://dx.doi.org/10.1055/s-0032-1329002.

Full text

APA, Harvard, Vancouver, ISO, and other styles

25

Nelzy, M. L., L. R. Salmi, S. Skopinski, J. C. Saby, P. Le Métayer, P. Morlat, C. Conri, and J. Constans. "Clinical Prediction of Lower Limb Deep Vein Thrombosis in Symptomatic Hospitalized Patients." Thrombosis and Haemostasis 86, no. 10 (2001): 985–90. http://dx.doi.org/10.1055/s-0037-1616521.

Full text

Abstract:

SummaryWe evaluated two clinical scores for the prediction of deep venous thrombosis (DVT) in hospitalized patients (Wells’ and Kahn’s). We included 273 patients referred to the vascular exploration unit for the suspicion of DVT. A clinical questionnaire was filled in by the practitioner and the scores were calculated from this form. 66 of the 273 patients had a DVT. When Wells’ score was 3, a DVT was found by duplex echography in 51% patients ; when the score was 0, a DVT was found in 9%. Kahn’s score was not adapted to this population. We then developed a new simple score (cancer, palsy or plaster immobilization, warmth, superficial venous dilation, unilateral pitting edema, other diagnosis). A DVT was found in 76% patients with a score of 3 and in 11% in those with a score of 0. We therefore propose a 6-item score whose main advantages are simplicity and usefulness in routine practice.

APA, Harvard, Vancouver, ISO, and other styles

26

Dhakal, Prajwal, Mian Harris Iftikhar, Ling Wang, Varunsiri Atti, Sagar Panthi, Xiao Ling, Mark T. P. Mujer, et al. "Overutilisation of imaging studies for diagnosis of pulmonary embolism: are we following the guidelines?" Postgraduate Medical Journal 95, no. 1126 (January 21, 2019): 420–24. http://dx.doi.org/10.1136/postgradmedj-2018-135995.

Full text

Abstract:

ObjectiveTo evaluate if imaging studies such as CT pulmonary angiography (CTPA) or ventilation–perfusion (V/Q) scan are ordered according to the current guidelines for the diagnosis of pulmonary embolism (PE).MethodsWe performed a retrospective observational cohort study in all adult patients who presented to the Sparrow Hospital Emergency Department from January 2014 to December 2016 and underwent CTPA or V/Q scan. We calculated the Wells’ score retrospectively, and d-dimer values were used to determine if the imaging study was justified.ResultsA total of 8449 patients underwent CTPA (93%) or V/Q scan (7%), among which 142 (1.7%) patients were diagnosed with PE. The Wells’ criteria showed low probabilities for PE in 96 % and intermediate or high probabilities in 4 % of total patients. Modified Wells’ criteria demonstrated PE unlikely in 99.6 % and PE likely in 0.4 % of total patients. D-dimer was obtained in only 37 % of patients who were unlikely to have a PE or had a low score on Wells’ criteria. Despite a low or unlikely Wells’ criteria score and normal d-dimer levels, 260 patients underwent imaging studies, and none were diagnosed with PE.ConclusionMore than 99 % of CTPA or V/Q scans were negative in our study. This suggests extraordinary overutilisation of the imaging methods. D-dimer, recommended in patients with low to moderate risk, was ordered in only one-third of patients. Much greater emphasis of current guidelines is needed to avoid inappropriate utilisation of resources without missing diagnosis of PE.

APA, Harvard, Vancouver, ISO, and other styles

27

Kraaijpoel, Noémie, Nick van Es, Harry R. Büller, Frederikus A. Klok, Menno V. Huisman, Paul L. den Exter, Javier Galipienzo, Saskia Middeldorp, and Patrick M. Bossuyt. "The Performance of the Original and Simplified Wells Scores in Combination with Age-Adjusted D-Dimer Testing in the Diagnostic Management of Pulmonary Embolism." Blood 128, no. 22 (December 2, 2016): 2569. http://dx.doi.org/10.1182/blood.v128.22.2569.2569.

Full text

Abstract:

Abstract Background: Among patients with suspected pulmonary embolism (PE), imaging can be safely withheld in those with a 'PE unlikely' Wells score and a negative D-dimer. A simplification of the Wells score has been proposed to improve clinical applicability (Table 1), but its performance is less clear, in particular in combination with age-adjusted D-dimer testing. Objectives: To compare the performance of the original and simplified Wells scores alone and in combination with age-adjusted D-dimer testing. Methods: Individual patient data from 7,268 patients with clinically suspected PE enrolled in 6 prospective diagnostic management studies were used. The discriminatory performance, calibration, and diagnostic accuracy of the original and simplified Wells scores were evaluated. The efficiency and failure rate of both dichotomized scores combined with age-adjusted D-dimer testing were compared using a one-stage random effects meta-analysis. Efficiency was defined as the proportion of patients in whom PE could be considered excluded based on a 'PE unlikely' Wells score and a D-dimer below the age-adjusted treshold, defined as ≤500 µg/L in patients of 50 years or younger and the patient's age times 10 µg/L in those older than 50 years. The failure rate was defined as the proportion of patients subsequently diagnosed with symptomatic venous thromboembolism during 3-month follow-up. Results: The discriminatory performance of the original and simplified Wells scores was comparable (c-statistic 0.73 [95% CI 0.72-0.75] vs. 0.72 [95% CI 0.70-0.73]). When combined with age-adjusted D-dimer testing, the original and simplified Wells rules had comparable efficiency (33% [95% CI 25-42%] vs 30% [95% CI 21-40%]) and failure rates (0.9% [95% CI 0.6-1.5%] vs. 0.8% [95% CI 0.5-1.3%]). Conclusion: Among patients with suspected PE, the original and simplified Wells rules in combination with age-adjusted D-dimer testing have similar performance in ruling out the disease. Given its ease of use in clinical practice, the simplified Wells rule may be preferred. Disclosures Huisman: Boehringer Ingelheim Pharma GmbH & Co.KG: Other: Grant support; GlaxoSmithKline: Other: Grant support; Bayer HealthCare: Other: Grant support; Pfizer: Other: Grant support; Actelion: Other: Grant support.

APA, Harvard, Vancouver, ISO, and other styles

28

Penaloza, Andrea, Christian Melot, and Serge Motte. "Comparison of the Wells score with the simplified revised Geneva score for assessing pretest probability of pulmonary embolism." Thrombosis Research 127, no. 2 (February 2011): 81–84. http://dx.doi.org/10.1016/j.thromres.2010.10.026.

Full text

APA, Harvard, Vancouver, ISO, and other styles

29

Touhami, Omar, Sofiene Ben Marzouk, Laidi Bennasr, Maha Touaibia, Iheb Souli, Mohamed Amine Felfel, Mehdi Kehila, Mohamed Badis Channoufi, and Hayen El Magherbi. "Are the Wells Score and the Revised Geneva Score valuable for the diagnosis of pulmonary embolism in pregnancy?" European Journal of Obstetrics & Gynecology and Reproductive Biology 221 (February 2018): 166–71. http://dx.doi.org/10.1016/j.ejogrb.2017.12.049.

Full text

APA, Harvard, Vancouver, ISO, and other styles

30

Ljungqvist, M., M. Soderberg, and P. Moritz. "Evaluation of Wells Score and Repeated D-Dimer in Diagnosing Venous Thromboembolism." Journal of Vascular Surgery 49, no. 4 (April 2009): 1084. http://dx.doi.org/10.1016/j.jvs.2009.02.025.

Full text

APA, Harvard, Vancouver, ISO, and other styles

31

Moneta, G. L. "Evaluation of Wells score and repeated D-dimer in diagnosing venous thromboembolism." Yearbook of Vascular Surgery 2009 (January 2009): 279–80. http://dx.doi.org/10.1016/s0749-4041(08)79066-3.

Full text

APA, Harvard, Vancouver, ISO, and other styles

32

Silveira, P. C., I. K. Ip, and S. Z. Goldhaber. "Performance of Wells Score for Deep Vein Thrombosis in the Inpatient Setting." Journal of Vascular Surgery 63, no. 2 (February 2016): 553. http://dx.doi.org/10.1016/j.jvs.2015.12.013.

Full text

APA, Harvard, Vancouver, ISO, and other styles

33

Silveira, Patricia C., Ivan K. Ip, Samuel Z. Goldhaber, Gregory Piazza, Carol B. Benson, and Ramin Khorasani. "Performance of Wells Score for Deep Vein Thrombosis in the Inpatient Setting." JAMA Internal Medicine 175, no. 7 (July 1, 2015): 1112. http://dx.doi.org/10.1001/jamainternmed.2015.1687.

Full text

APA, Harvard, Vancouver, ISO, and other styles

34

Ljungqvist, Maria, Mårten Söderberg, Per Moritz, Anders Ahlgren, and Gerd Lärfars. "Evaluation of Wells score and repeated D-dimer in diagnosing venous thromboembolism." European Journal of Internal Medicine 19, no. 4 (June 2008): 285–88. http://dx.doi.org/10.1016/j.ejim.2007.08.007.

Full text

APA, Harvard, Vancouver, ISO, and other styles

35

Angriman, Federico, Bruno L. Ferreyro, María L. Posadas-Martinez, Diego Giunta, Fernando J. Vazquez, and William M. Vollmer. "Wells Score and Poor Outcomes Among Adult Patients With Subsegmental Pulmonary Embolism." Clinical and Applied Thrombosis/Hemostasis 21, no. 6 (November 25, 2014): 539–45. http://dx.doi.org/10.1177/1076029614559772.

Full text

APA, Harvard, Vancouver, ISO, and other styles

36

Vakde, Trupti, Ajit Lale, Misbahuddin Khaja, Gilda Diaz-Fuentes, and Sindhaghatta Venkatram. "Venous Thromboembolism in the Medical Intensive Care Unit. Is Wells Score Predictive?" Chest 142, no. 4 (October 2012): 856A. http://dx.doi.org/10.1378/chest.1388407.

Full text

APA, Harvard, Vancouver, ISO, and other styles

37

Lesmana, Andy, Dedy Pratama, and Grace Wangge. "Comparison of Wells Score, D–Dimer and Combination of Wells Score and D–Dimer with Venous Duplex Ultrasonography in Diagnosis of Acute Deep Vein Thrombosis in Lower Extremity." New Ropanasuri Journal of Surgery 2, no. 1 (April 30, 2017): 21–24. http://dx.doi.org/10.7454/nrjs.v2i1.17.

Full text

APA, Harvard, Vancouver, ISO, and other styles

38

Kennedy, Nick, Sisira Jayathissa, and Paul Healy. "Investigation of Suspected Pulmonary Embolism at Hutt Valley Hospital with CT Pulmonary Angiography: Current Practice and Opportunities for Improvement." Advances in Medicine 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/357576.

Full text

Abstract:

Aims. To study the use of CT pulmonary angiography (CTPA) at Hutt Hospital and investigate the use of pretest probability scoring in the assessment of patients with suspected pulmonary embolism (PE).Methods. We studied patients with suspected PE that underwent CTPA between January and May 2012 and collected data on demographics, use of pretest probability scoring, and use of D Dimer and compared our practice with the British Thoracic Society (BTS) guideline.Results. 105 patients underwent CTPA and 15% of patients had PE. 13% of patients had a Wells score prior to their scan. Wells score calculated by researchers revealed 54%, 36%, and 8% patients had low, medium, and high risk pretest probabilities and 8%, 20%, and 50% of these patients had positive scans. D Dimer was performed in 58% of patients and no patients with a negative D Dimer had a PE.Conclusion. The CTPA positive rate was similar to other contemporary studies but lower than previous New Zealand studies and some international guidelines. Risk stratification of suspected PE using Wells score and D Dimer was underutilised. A number of scans could have been safely avoided by using accepted guidelines reducing resources use and improving patient safety.

APA, Harvard, Vancouver, ISO, and other styles

39

Sambataro, Domenico, Gianluca Sambataro, Francesca Pignataro, Wanda Maglione, Lorenzo Malatino, Carlo Vancheri, Michele Colaci, and Nicoletta Del Papa. "Quantification of Ground Glass Opacities Can Be Useful to Describe Disease Activity in Systemic Sclerosis." Diagnostics 10, no. 4 (April 16, 2020): 225. http://dx.doi.org/10.3390/diagnostics10040225.

Full text

Abstract:

Interstitial lung disease (ILD) is the main cause of death in systemic sclerosis (SSc) patients. Usually, patients have lung involvement characterized by ground glass opacities (GGOs), but honeycombing (HC) is also possible. The Wells score is a semi-quantitative index, which is able to assess ILD by distinguishing its main components. The aim of this work is to evaluate the Wells score in relation to the disease activity (DA) index. We enrolled 40 consecutive SSc-ILD patients (26 diffuse cutaneous form, dcSSc, and 14 limited form, lcSSc). All patients were evaluated by the European Scleroderma Study Group (ESSG) index, high-resolution computed tomography, transthoracic echocardiogram, pulmonary function tests (PTSs), and nailfold videocapillaroscopy for the number of microhemorrhages (NEMO) score. In our study, the total extent of ILD (TE-ILD), fibrosis and GGOs correlated with dyspnea (p = 0.03, 0.01 and 0.01 respectively), but not with the ESSG index. Considering only the dcSSc patients, TE-ILD and GGOs correlated with the ESSG index (r = 0.5 p = 0.009), while fibrosis grade correlated with disease duration and systolic pulmonary artery pressure. In conclusion, our data suggest that GGO correlates with DA, while fibrosis may be a sign of disease damage. The quantification of pulmonary involvement using the Wells score can be a useful tool for assessing the appropriate treatment in SSc patients.

APA, Harvard, Vancouver, ISO, and other styles

40

Oliver, Monika, Mariam Goubran, Jacqueline Karathra, Mohammad Karkhaneh, and Cynthia M. Wu. "A Retrospective Review of the Appropriateness of D-Dimer Ordering and Interpretation Using Wells' Clinical Probability Criteria." Blood 136, Supplement 1 (November 5, 2020): 28–29. http://dx.doi.org/10.1182/blood-2020-136019.

Full text

Abstract:

Introduction The D-dimer has been validated in diagnostic venous thromboembolism (VTE) algorithms. The high sensitivity of the assay allows for safe exclusion of VTE in patients with low clinical pre-test probability and a negative D-dimer. The Wells score for Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) are validated pre-test probability tools which help guide physicians on when to order a D-dimer in patients with suspected VTE. However, we suspect these scoring tools are often under-utilized by physicians leading to inappropriate D-dimer ordering and subsequent interventions. We sought to explore the landscape of D-dimer ordering at our institution. Methods We conducted a retrospective chart review of 482 patients in whom a D-dimer had been ordered over a 3-month period at the University of Alberta Hospital, a tertiary care teaching hospital in Edmonton, Canada. Charts were reviewed for patient demographics, specialty of ordering physician, apparent indication for ordering, patient risk factors for VTE and evidence of a pre-test probability (PTP) calculation. WIf no PTP score was documented, we retrospectively calculated Wells DVT or PE scores. VTE was deemed likely with a calculated Wells score for DVT ≧2 or Wells score for PE >4. In the case of high PTP for PE, patients should go directly to imaging and a D-dimer should not be performed. A cut off of ≥ 0.50 mg/L was deemed a positive D-dimer (STA-LIATEST). We also reviewed subsequent investigations thought to be influenced by interpretation of the D-dimer including: ventilation/perfusion (V/Q) and pulmonary angiography (CTPA) scans, and upper and lower extremity doppler ultrasound studies. We then used multivariable logistic regression analysis to evaluate the proportion of patients who received imaging despite a low PTP and negative D-dimer. Results Seventy eight percent of D-dimers were ordered by Emergency physicians while 15.3% were drawn on admitted patients, and 5.8% in the outpatient setting. The indication for ordering was unknown in 87 (17.5%) of cases. Pre-test probability scores were documented in only 8 (1.6%) of cases. All of those documented were the Wells PE score. When Wells DVT and PE scores were calculated retrospectively, 30.0% and 17.1% (87 cases) were deemed 'likely' for VTE, respectively. However, imaging was performed in 172 cases (34.6%), including in 36 cases despite a negative D-dimer result and low PTP. In contrast, 68 cases (17.2%) had a D-dimer performed with a high Wells PTP for PE despite the recommendation to proceed directly to imaging. VTE (either DVT or PE) was confirmed by imaging in 32 (18.6%) of cases, the majority (53.1%) had a high retrospective PTP. Conclusions Inappropriate ordering and interpretation of D-dimers remains a significant problem despite the implementation of clinical guidelines and pre-test probability algorithms, namely the Wells score for DVT and PE meant to guide physicians. This leads to unnecessary cost, radiation exposure, and prolonged contact with the health care system for patients. This suggests the need for quality improvement initiatives which draw physician's attention to pre-test probability tools which can curbing subsequent inappropriate investigations and improve patient care. Disclosures Wu: Servier: Other: advisory board; BMS-pfizer: Honoraria, Other: advisory board; leo pharma: Other: advisory board; Pfizer: Honoraria.

APA, Harvard, Vancouver, ISO, and other styles

41

Oguntoke, Olusegun, Oluseye A. Komolafe, and Harold J. Annegarn. "Statistical analysis of shallow well characteristics as indicators of water quality in parts of Ibadan City, Nigeria." Journal of Water, Sanitation and Hygiene for Development 3, no. 4 (August 17, 2013): 602–11. http://dx.doi.org/10.2166/washdev.2013.066.

Full text

Abstract:

The inability of private well-owners to conduct well-water tests is a major obstacle to addressing contamination of water for human consumption in Ibadan city. Shallow well characteristics and their water quality were assessed with the aim of identifying observable characteristics that serve as markers of well water status. Field observation and interviews were employed to assess the features of 100 shallow wells. In addition, physicochemical and bacteriological parameters of water samples from selected wells were analysed. Out of 100 wells, the aggregate score of 60% ranged from high to medium risk. The mean concentrations of manganese, iron, total dissolved solids, pH and bacterial population were outside the WHO permissible limit in more than 50% of the sampled wells. Wells with poor locational characteristics had high turbidity and bacterial population (P < 0.05). A regression model showed that improved structural and maintenance scores of wells will reduce bacterial load in the well water; hence their scores can indicate water quality status.

APA, Harvard, Vancouver, ISO, and other styles

42

Gómez-Jabalera, Efrem, Sergio Bellmunt Montoya, Eva Fuentes-Camps, and José Román Escudero Rodríguez. "Age-adjusted D-dimer for the diagnosis of deep vein thrombosis." Phlebology: The Journal of Venous Disease 33, no. 7 (July 5, 2017): 458–63. http://dx.doi.org/10.1177/0268355517718762.

Full text

Abstract:

Objective In the diagnosis of deep vein thrombosis, new D-dimer cut-off values were defined by multiplying 10 µg/L × age. The objective of the present study is to define a more specific age-adjusted value, including the pre-test Wells score, without worsening sensitivity. Methods We designed a case–control study in patients attended in the emergency department with clinically suspected deep vein thrombosis. Demographics, Wells score, D-dimer and ultrasound data were collected. In low and intermediate clinical probability cases for deep vein thrombosis, we determined the specificity and sensitivity (false-negative rates) for the following cut-off values of D-dimer: age × 10 µg/L, age × 15 µg/L, age × 20 µg/L, age × 25 µg/L and age × 30 µg/L. The cut-off value with maximum specificity without any false-negative result (sensitivity 100%) was identified. Results We included 138 consecutive patients, 39.9% were men and the mean age was 71.6 years. Deep vein thrombosis was diagnosed in 16.7% of patients and the Wells score was low in 69.6%, intermediate in 21% and high in 9.4% of patients. Applying the conventional cut-off value of 500 µg/L, the specificity was 21.1% with a sensitivity of 100%. Maintaining 100% sensitivity, the highest specificity was reached with a cut-off value for D-dimer equivalent to the age × 25 µg/L in low-risk patients (67.1% specificity) and the age × 10 µg/L (50% specificity) in intermediate-risk patients. Conclusions In patients with low Wells score, the cut-off value can be raised to age × 25 µg/L in order to rule out deep vein thrombosis without jeopardizing safety. In intermediate-risk patients, the D-dimer cut-off value could be raised to age × 10 µg/L as previously suggested.

APA, Harvard, Vancouver, ISO, and other styles

43

Simon, Michael A., Christopher Tan, Patrick Hilden, Lyle Gesner, and Barry Julius. "Effectiveness of Clinical Decision Tools in Predicting Pulmonary Embolism." Pulmonary Medicine 2021 (February 19, 2021): 1–5. http://dx.doi.org/10.1155/2021/8880893.

Full text

Abstract:

Objective. The Wells criteria and revised Geneva score are two commonly used clinical decision tools (CDTs) developed to assist physicians in determining when computed tomographic angiograms (CTAs) should be performed to evaluate the high index of suspicion for pulmonary embolism (PE). Studies have shown varied accuracy in these CDTs in identifying PE, and we sought to determine their accuracy within our patient population. Methods. Patients admitted to the Emergency Department (ED) who received a CTA for suspected PE from 2019 Jun 1 to 2019 Aug 31 were identified. Two CDTSs, the Wells criteria and revised Geneva score, were calculated based on data available prior to CTA and using the common D-Dimer cutoff of >500 μg/L. We determined the association between confirmed PE and CDT values and determined the association between the D-Dimer result and PE. Results. 392 CTAs were identified with 48 (12.1%) positive PE cases. The Wells criteria and revised Geneva score were significantly associated with PE but failed to identify 12.5% and 70.4% of positive PE cases, respectively. Within our cohort, a D-Dimer cutoff of >300 μg/L was significantly associated with PE and captured 95.2% of PE cases. Conclusions. Both CDTs were significantly associated with PE but failed to identify PE in a significant number of cases, particularly the revised Geneva score. Alternative D-Dimer cutoffs may provide better accuracy in identifying PE cases.

APA, Harvard, Vancouver, ISO, and other styles

44

Korevaar, Daniël A., Jérémie F. Cohen, and Josien van Es. "YEARS Algorithm Versus Wells’ Score: Incomplete Reporting Undermines Study Quality Assessment—Part 2." Critical Care Medicine 48, no. 12 (November 20, 2020): e1377-e1378. http://dx.doi.org/10.1097/ccm.0000000000004608.

Full text

APA, Harvard, Vancouver, ISO, and other styles

45

Riess, Hanno, Viola Hach-Wunderle, Horst Gerlach, Heike Carnarius, Sonja Eberle, Eberhard Rabe, Sebastian Schellong, and Rupert Bauersachs. "Impact of gender on the clinical presentation and diagnosis of deep-vein thrombosis." Thrombosis and Haemostasis 103, no. 04 (2010): 710–17. http://dx.doi.org/10.1160/th09-10-0705.

Full text

Abstract:

SummaryIt is uncertain whether gender influences the clinical presentation of deep-vein thrombosis (DVT) and the discriminative value of the Wells diagnostic pretest probability score. The aim of the study was to determine whether gender impacts the clinical presentation and diagnosis of DVT. The study analysed a cohort of 4,976 outpatients with clinically suspected DVT of the leg prospectively recruited by 326 vascular medicine physicians in the German ambulatory care sector between October and December 2005. The diagnosis of DVT was based on compression ultrasonography in 96% of patients. Among 4,777 patients who had a diagnostic work-up for DVT there were more women (n=2,998) than men (n=1,779). However, the prevalence of confirmed DVT was 37.0% (658/1779) in men vs. 24.3% (730/2,998) in women (p<0.001). Among patients with confirmed DVT, proximal DVT was more common in men (59.6% vs. 44.5% in women, p<0.001). Swelling of the leg, pitting oedema and dilated superficial veins were more frequently reported by men (p<0.001). The percentage of patients with a high probability Wells clinical pretest score was higher in men than in women (67.0% vs. 57.0%, p<0.001). However, overall, the score equally discriminated risk groups for DVT in both sexes. In conclusion, women were more frequently referred for a diagnostic work-up for DVT than men, but the prevalence of DVT was higher in men and their thrombotic events were more severe. Nevertheless, the Wells clinical pretest probability score correctly identified low- and high-risk groups in both genders.

APA, Harvard, Vancouver, ISO, and other styles

46

Alasiry, Erny, Andi Fachruddin Benyamin, Sahyuddin Saleh, Syakib Bakri, Muhammad Ilyas, Hasyim Kasim, Idar Mapangara, and Arifin Seweng. "Correlation of Wells Score, Prothrombin Time, Activated Partial Thromboplastin Time, Fibrinogen and D-Dimer Levels with Doppler Ultrasonography in Suspected Deep Vein Thrombosis Patients." Global Journal of Health Science 12, no. 11 (September 4, 2020): 1. http://dx.doi.org/10.5539/gjhs.v12n11p1.

Full text

Abstract:

BACKGROUND/AIM: Venous thromboembolism (VTE) occur from formation of blood clots in the veins, which are mostly composed of fibrin and red blood cells with a small component of leukocytes and platelets. Most VTE manifests as deep vein thrombosis (DVT) and pulmonary embolism (PE). The lack of availability of Doppler ultrasound in health facilities especially in remote areas, makes the diagnosis of DVT challenging. There for, history taking, physical examination and laboratory findings are very important in diagnosing DVT especially in those area where Doppler ultrasound unavailable. Based on this we study the correlation Wells scores, Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), Fibrinogen, and D-Dimer levels with the findings on Doppler ultrasound in patients with suspected DVT in Wahidin Sudirohusodo Hospital Makassar. METHOD: The study was conducted in Department of Internal Medicine, Wahidin Sudirohusodo Hospital Makassar from 2018 to 2019. Subjects were inpatients in Department of Internal Medicine with DVT suspicion. Wells scores, PT, APTT, Fibrinogen, D-Dimer levels and Doppler ultrasound results of all subjects were recorded and then analyzed. The patient is DVT positive if confirmed by Doppler Ultrasonography. Statistical analysis was performed by descriptive statistical calculations and frequency distribution as well as the Independent-t statistical test, Chi Square test and Fisher Exact test. RESULTS: Among 38 subject, 24 were men (63.2%) and 14 were women (36.8%). We found higher Wells score, shortened PT and APTT, increased fibrinogen in subject with positive Doppler ultrasound, without a significant correlation. A significant correlation was found between increased D-Dimer levels positive Doppler ultrasound results (79.4%, p = 0.048). When Wells score is added with analysis a significant correlation was also found (80.6%, p = 0.044). CONCLUSION: A significant correlation was found between increased D-Dimer levels positive Doppler ultrasound results (79.4%, p = 0.048). When Wells score is added with analysis a significant correlation was also found (80.6%, p = 0.044).

APA, Harvard, Vancouver, ISO, and other styles

47

Panic, Dragan, Andreja Todorovic, Milica Stanojevic, and Violeta Iric Cupic. "Wells’ Score in Diagnosis of Pulmonary Embolism in Patient with Thrombocytopenia: A Case Report." Serbian Journal of Experimental and Clinical Research 20, no. 3 (September 1, 2019): 281–85. http://dx.doi.org/10.1515/sjecr-2017-0061.

Full text

Abstract:

Abstract Current diagnostic workup of patients with suspected acute pulmonary embolism (PE) usually starts with the assessment of clinical pretest probability, using clinical prediction rules and plasma D-dimer measurement. Although an accurate diagnosis of acute pulmonary embolism (PE) in patients is thus of crucial importance, the diagnostic management of suspected PE is still challenging. A 60-year-old man with chest pain and expectoration of blood was admitted to the Department of Cardiology, General Hospital in Cuprija, Serbia. After physical examination and laboratory analyses, the diagnosis of Right side pleuropne monia and acute pulmonary embolism was established. Clinically, patient was hemodynamically stable, auscultative slightly weaker respiratory sound right basal, without pretibial edema. Laboratory: C-reactive protein (CRP) 132.9 mg/L, Leukocytes (Le) 18.9x109/L, Erythrocytes (Er) 3.23x1012/L, Haemoglobin (Hgb) 113 g/L, Platelets (Plt) 79x109/L, D-dimer 35.2. On the third day after admission, D-dimer was increased and platelet count was decreased (Plt up to 62x109/L). According to Wells’ rules, score was 2.5 (without symptoms on admission), a normal clinical finding with clinical manifestation of hemoptysis and chest pain, which represents the intermediate level of clinical probability of PE. After the recidive of PE, Wells’ score was 6.5. In summary, this study suggests that Wells’ score, based on a patient’s risk for pulmonary embolism, is a valuable guidance for decision-making in combination with knowledge and experience of clinicians. Clinicians should use validated clinical prediction rules to estimate pretest probability in patients in whom acute PE is being consiered.

APA, Harvard, Vancouver, ISO, and other styles

48

Merembayev, Timur, Darkhan Kurmangaliyev, Bakhbergen Bekbauov, and Yerlan Amanbek. "A Comparison of Machine Learning Algorithms in Predicting Lithofacies: Case Studies from Norway and Kazakhstan." Energies 14, no. 7 (March 29, 2021): 1896. http://dx.doi.org/10.3390/en14071896.

Full text

Abstract:

Defining distinctive areas of the physical properties of rocks plays an important role in reservoir evaluation and hydrocarbon production as core data are challenging to obtain from all wells. In this work, we study the evaluation of lithofacies values using the machine learning algorithms in the determination of classification from various well log data of Kazakhstan and Norway. We also use the wavelet-transformed data in machine learning algorithms to identify geological properties from the well log data. Numerical results are presented for the multiple oil and gas reservoir data which contain more than 90 released wells from Norway and 10 wells from the Kazakhstan field. We have compared the the machine learning algorithms including KNN, Decision Tree, Random Forest, XGBoost, and LightGBM. The evaluation of the model score is conducted by using metrics such as accuracy, Hamming loss, and penalty matrix. In addition, the influence of the dataset features on the prediction is investigated using the machine learning algorithms. The result of research shows that the Random Forest model has the best score among considered algorithms. In addition, the results are consistent with outcome of the SHapley Additive exPlanations (SHAP) framework.

APA, Harvard, Vancouver, ISO, and other styles

49

Sharif, S., C. Kearon, M. Eventov, P. Sneath, M. Li, and K. deWit. "LO55: Comparison of the age-adjusted D-dimer, clinical probability-adjusted D-dimer, and Wells rule with D-dimer for diagnosing deep vein thrombosis in the emergency department." CJEM 22, S1 (May 2020): S27. http://dx.doi.org/10.1017/cem.2020.110.

Full text

Abstract:

Introduction: Diagnosing deep vein thrombosis (DVT) is of critical importance because of its associated morbidity and mortality. Diagnosing DVT can be challenging in the Emergency Department (ED) due to inconsistent adherence to, and utilization of the Wells rule. Both the age-adjusted and clinical probability adjusted D-dimer have been shown to decrease ultrasound (US) utilization rates. We aimed to compare the safety and efficacy of the Wells score with D-dimer to the age-adjusted and clinical probability-adjusted D-dimer in Canadian ED patients tested for DVT. Methods: This was a health records review of ED patients investigated for DVT at two EDs over a two-year period. Inclusion criteria were ED physician ordered duplex ultrasonography or D-dimer for investigation of lower limb DVT. Patients under the age of 18 were excluded. DVT was considered to be present during the ED visit if DVT was diagnosed on duplex ultrasonography and was treated for acute DVT, or if the patient was subsequently diagnosed with pulmonary embolism (PE) or DVT during the next 30 days. Trained researchers extracted anonymized data. The Wells D-dimer, age-adjusted D-dimer, and the clinical probability-adjusted D-dimer rules were applied retrospectively. The rate of duplex ultrasonography imaging and the false negative rate was calculated for each rule. Results: Between April 1st 2013 and March 31st 2015, there were 1,198 patients tested for DVT. Of the low and moderate clinical pretest probability patients (Wells score ≤ 2), only 436 had a D-Dimer test and were eligible for our analysis. The average age of the patients was 59, 56% were female, and 4% had a malignancy. 207/436 patients (47.4%, 95%CI 42.8-52.2%) would have had US imaging for DVT if the age-adjusted D-dimer rule was used. 214/436 patients (49.1%, 95%CI 44.4-53.8%) would have had imaging for DVT if the clinical probability-adjusted D-dimer was used. If the Wells rule was used with the standard D-dimer cutoff of 500, 241/436 patients (55.2%, 95%CI 50.6-59.9%) would have had imaging for DVT. The false-negative rate for the Wells rule was 1.5% (95%CI 0.5-4.4%). The false-negative rate for the age-adjusted D-dimer rule was 1.3% (95%CI 0.4-3.8%). The false-negative rate for the clinical-probability adjusted D-Dimer was 1.8% (95%CI 0.7-4.5%). Conclusion: In comparison with the approach of the Wells score and D-dimer, both the age-adjusted and clinical probability-adjusted D-dimer diagnostic strategies could reduce the proportion of patients who require US imaging.

APA, Harvard, Vancouver, ISO, and other styles

50

Mos, Inge, Renée Douma, Petra Erkens, Marc Durian, Tessa Nizet, Anja van Houten, Herman Hofstee, et al. "The combination of four different clinical decision rules and an age-adjusted D-dimer cut-off increases the number of patients in whom acute pulmonary embolism can safely be excluded." Thrombosis and Haemostasis 107, no. 01 (2012): 167–71. http://dx.doi.org/10.1160/th11-08-0587.

Full text

Abstract:

SummaryFour clinical decision rules (CDRs) (Wells score, Revised Geneva Score (RGS), simplified Wells score and simplified RGS) safely exclude pulmonary embolism (PE), when combined with a normal D-dimer test. Recently, an age-adjusted cut-off of the D-dimer (patient’s age x 10 μg/l) safely increased the number of patients above 50 years in whom PE could safely be excluded. We validated the age-adjusted D-dimer test and assessed its performance in combination with the four CDRs in patients with suspected PE. A total of 414 consecutive patients with suspected PE who were older than 50 years were included. The proportion of patients in whom PE could be excluded with an ‘unlikely’ clinical probability combined with a normal age-adjusted D-dimer test was calculated and compared with the proportion using the conventional D-dimer cut-off. We assessed venous thromboembolism (VTE) failure rates during three months follow-up. In patients above 50 years, a normal age-adjusted D-dimer level in combination with an ‘unlikely’ CDR substantially increased the number of patients in whom PE could be safely excluded: from 13–14% to 19–22% in all CDRs similarly. In patients over 70 years, the number of exclusions was nearly four-fold higher, and the original Wells score excluded most patients, with an increase from 6% to 21% combined with the conventional and age-adjusted D-dimer cut-off, respectively. The number of VTE failures was also comparable in all CDRs. In conclusion, irrespective of which CDR is used, the age-adjusted D-dimer substantially increases the number of patients above 50 years in whom PE can be safely excluded.

APA, Harvard, Vancouver, ISO, and other styles

Journal articles on the topic 'Wells-Score'

Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles