Clinical Study on the Screening of Lower Extremity Deep Venous Thrombosis by D-Dimer Combined with RAPT Score Among Orth
- PDF / 772,397 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 82 Downloads / 154 Views
ORIGINAL ARTICLE
Clinical Study on the Screening of Lower Extremity Deep Venous Thrombosis by D‑Dimer Combined with RAPT Score Among Orthopedic Trauma Patients Xin Zhao1 · Salma Juma Ali2 · Xiguang Sang1 Received: 29 February 2020 / Accepted: 18 September 2020 / Published online: 28 September 2020 © Indian Orthopaedics Association 2020
Abstract Background Among the causes of mortality in patients with lower extremity fracture following surgery, lower extremity deep venous thrombosis (DVT) is a leading one. To lower the morbidity and mortality, early screening and preventive anticoagulation therapy are essential in clinical study. Common screening methods, including risk prediction tools, imaging tests and D-dimer test, had various drawbacks. The study aimed to establish a new method, that is, D-dimer combined with Risk Assessment and Predictor Tool (RAPT) score, for screening the lower extremity DVT among patients with lower extremity fracture and evaluate its clinical value. Materials and Methods The RAPT score, plasma D-dimer and lower extremity venous ultrasonography examination reports were collected from Department of Emergency Surgery & Orthopaedic Surgery from July 2019 to December 2019, and the data were analyzed retrospectively. Regarding the lower extremity venous ultrasonography examination report as the "gold standard" to determine whether DVT exists, the sensitivity, specificity and area under the curve (AUC) of RAPT score alone, plasma D-dimer alone and combination of them in screening lower extremity DVT were analyzed and evaluated. Results 197 patients were enrolled in the study. There were significant differences in D-dimer level and RAPT score between DVT group and non-DVT group (P 3 weeks); (2) pathological fracture; (3) coagulopathy; (4) incomplete information.
S317
performed within 24 h after admission and on the 2nd day after operation. Patients diagnosed as thrombosis by ultrasound would transfer to full anticoagulation therapy. Data of plasma D-dimer, lower extremity venous ultrasound report and RAPT score of the patients on the 2nd day after operation were retrospectively collected. Patients were divided into DVT group and non-DVT group, based on ultrasound report as the gold standard. Age, sex, RAPT score and D-dimer were compared between the two groups. According to RAPT score, the diagnosis of DVT was ruled out for those patients in the low-risk group and further examination was needed for those in the intermediate and high-risk group. The sensitivity, specificity, positive and negative predictive value, and area under the receiver operating characteristic (ROC) curve (AUC) of RAPT score and D-dimer were evaluated, respectively, Given the poor specificity of D-dimer threshold used widely nowadays (0.5 μg/ml), we put forward a new D-dimer threshold derived from ROC curve combined with Youden’s index. The diagnosis of the lower extremity DVT was excluded for the patients whose RAPT score was estimated to be low-risk and D-dimer was less than the new D-dimer threshold, otherwise, th
Data Loading...
