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Comment & Response |

Imaging Tests for Suspected Deep Vein Thrombosis

Frederikus A. Klok, MD, PhD1; Maria Alexandra Sleddering, MD, PhD2; Menno V. Huisman, MD, PhD1
[+] Author Affiliations
1Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
2Department of General Internal Medicine, Bronovo Hospital, the Hague, the Netherlands
JAMA Intern Med. 2015;175(11):1873-1874. doi:10.1001/jamainternmed.2015.5586.
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To the Editor It is with great interest that we read the article by Silveira et al1 regarding the utility of the Wells score for inpatients with suspected deep vein thrombosis (DVT). Based on the presented data, we agree that the accuracy of the Wells score for risk stratification of inpatients seems to be inferior to outpatients, although it should be noted the authors have not performed a direct comparison between both groups. This conclusion should be interpreted in the perspective of the complete diagnostic algorithm of suspected DVT since the Wells score was not designed as a stand-alone diagnostic test but rather as a first-line tool for determining the optimal order of subsequent imaging and/or blood tests to rule out or establish the diagnosis.2,3 A diagnostic strategy4 starting with the Wells score and followed by a D-dimer test and/or compression ultrasonography (CU) was shown to safely rule out DVT with an associated negative predictive value of greater than 99.5% and an average of 0.8 CU examinations per patient. It is unfortunate that D-dimer blood levels were not available in a larger number of patients in the study by Silveira et al,1 which would have provided more insight into the true diagnostic service of the Wells score in the patient category under study.1

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November 1, 2015
Patricia C. Silveira, MD; Ivan K. Ip, MD, MPH; Ramin Khorasani, MD, MPH
1Center for Evidence-Based Imaging, Departments of Radiology and Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. 2015;175(11):1874. doi:10.1001/jamainternmed.2015.5589.
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