Advanced Health Assessment: Venous Thromboembolism

What Does This Review Ask?

The review compares the levels of accuracy of several rules for clinical prediction of deep vein thrombosis and pulmonary embolism and tries to determine what rule of diagnosis of deep vein thrombosis is the most effective and often used. The objective of the study is “To summarize the evidence on the predictive value of clinical prediction rules for the diagnosis of venous thromboembolism” (Tamariz et al., 2004, p. 676).

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The methods were based on selected studies of clinical prediction rules and are as follows: literature search and abstract review, qualitative and quantitative assessment, and statistical analysis. The paper also reviews such prediction rules as the Wells Prediction Rule for deep vein thrombosis, the Wells Prediction Rule for pulmonary embolism, and some other clinical prediction rules for the diagnosis of deep vein thrombosis (Tamariz et al., 2004, p. 678). The expected results were to evaluate prediction rules for the diagnosis of deep venous thrombosis and pulmonary embolism.

What Are The Elements of This Review?

The review consists of several parts. After a brief introduction, it states the basic methods of reviewing, describes each of them, and moves on to talk about prediction rules. The review deals with two cardiac disorders – deep vein thrombosis and pulmonary embolism that together constitute venous thromboembolism (Ozaki & Bartholomew, 2012, para. 1). Prediction rules are the main focus of the paper.

The results show that out of 72 articles that were researched to make this review only 23 proved to be relevant to the study. Those studies are represented in the article in a table form: one table consists of 17 research data reports (deep vein thrombosis), and the other one compiles the remaining six (pulmonary embolism). The final results show that the risk factors were not reported often in the case of pulmonary embolism. When it came to the diagnosis of deep vein thrombosis, the rates were more fluctuating: the majority of risk factors were reported in a form of surgeries and immobilization, and a small percentage had malignancy (Tamariz et al., 2004, p. 768).

The use of both types of Wells Prediction Rules shows satisfactory results on their own as well as with the additional application of rapid latex D-dimer assay (Tamariz et al., 2004, p. 676). The prediction rules can be applied in my practice as the diagnostic rules for patients who are statistically more prone to risk factors in regards to deep vein thrombosis. The rules will also help me determine the patients who demonstrate a low probability of succumbing to the disease and whose wellbeing, therefore, may be secured without further testing (Tamariz et al., 2004, p. 683).

Who Funded the Review?

According to the notes at the beginning of the review, the research was conducted and, therefore, funded by the Johns Hopkins Evidence-Based Practice Center, Baltimore, Maryland, with the contributions from the researchers from the Johns Hopkins University School of Medicine, Johns Hopkins University Bloomberg School of Public Health, the Department of Medicine, the Russell H. Morgan Department of Radiology and Radiological Science, the Departments of Epidemiology and Health Policy and Management. It is also mentioned that Dr. Tamariz (2004) has received a training grant in behavioral research from the National Heart Lung and Blood Institute (p. 676).

The Strengths and Limitations of the Review

The strong sides of the review include clear and compelling results; solid, carefully picked sources; well explained yet concise definitions of both types of Wells Prediction Rules and schematic yet comprehensive descriptions of other Prediction Rules. Well-rounded conclusions indicate concrete results and answer the asked questions.

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The weaknesses are the fact that patients who used to have a history of thrombosis in their family, suffered from venous thromboembolism before, or had complications like malignancy and concomitant pulmonary embolism were not included in the research; and, therefore, many of the acquired results cannot be applied to them (Tamariz et al., 2004, p. 683). However, the instrument used in the research quality evaluation “included items that frequently have been cited as important” (Tamariz et al., 2004, p. 683).

Was The Objective Accomplished?

The objective of the study, “To summarize the evidence on the predictive value of clinical prediction rules for the diagnosis of venous thromboembolism” (Tamariz et al., 2004, p. 676), was accomplished as the results summarized what had been learned about prediction rules and showed the most useful ones for venous thromboembolism diagnosis. The most frequently evaluated one turned out to be the Wells Prediction Rule.

Its median positive likelihood ratios constituted 6.62 for patients with a high pretest probability, 1 for moderate pretest probability, and 0.22 for low pretest probability (Tamariz et al., 2004, p. 676). The Wells Prediction Rule was given the most amount of attention during the pulmonary embolus study and had median positive likelihood ratios of 6.75 for patients with high pretest probability, 1.82 for moderate pretest probability, and 0.13 for low pretest probability (Tamariz et al., 2004, p. 676).

My Thoughts on the Review

I think, despite the limitations, the review provided clear and concise results concerning the group it was targeted at without demanding too many resources and posing too many difficulties during implementation. Considering that approximately 44,000 people die of venous thromboembolism every year in the United States, this study is very important and valuable (American Heart Association, 2015, para. 8). Venous thromboembolism is considered a widespread, lethal disease; most hospitalized patients have risk factors for it, and it results in dangerous long-term complications like chronic thromboembolic pulmonary hypertension (CTPH) and the post-thrombotic syndrome (PTS) (Ozaki & Bartholomew, 2012, para. 1).

Since this study came out in 2004, and we still either experience problems in the treatment of people who suffer deep vein thrombosis (about two million annually) or overlook the disease altogether, we need more research to keep our attention on the problem. Concentrating on the prediction rules and finding better ways to utilize them is always a big step forward and a great motivation to study other diseases that usually accompany venous thromboembolism such as cancer of unknown primary origin (Fennerty, 2006).

I think, in my practice, the Wells Clinical Prediction Rules will help me and other medical professionals to determine the probability of deep vein thrombosis with more precision. If we use the rules in combination with a negative D-dimer test, we will also achieve profitable results. Negative D-dimer results and the Wells Prediction Rules will also make pulmonary embolism diagnosis more accurate (Pulivarthi & Gurram, 2014). The Wells Prediction Rules for pulmonary embolism and deep vein thrombosis will show a clear link between various cardiovascular risk factors (smoking, hypertension, high cholesterol levels, etc.) and the disease (Corrales-Rodriguez & Blais, 2012).

Nevertheless, further research is needed. The Wells Clinical Prediction Rules’ scope of utilization should be evaluated, the difficulties concerning their use should be downplayed, and the possible positive outcomes or their use should be studied in more detail and improved on.

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American Heart Association. (2015). Venous Thromboembolism (VTE). Web.

Corrales-Rodriguez, L., & Blais, N. (2012). Lung Cancer-Associated Venous Thromboembolic Disease: A Comprehensive Review. Lung Cancer, 75(1), 1-8.

Fennerty, A. (2006). Venous Thromboembolic Disease and Cancer. Postgraduate Medical Journal, 82(972), 642-648.

Ozaki, A., & Bartholomew, J. R. (2012). Venous Thromboembolism (Deep Venous Thrombosis & Pulmonary Embolism). Web.

Pulivarthi, S., & Gurram, M. K. (2014). Effectiveness of D-dimer as a Screening Test for Venous Thromboembolism: An Update. North American Journal Of Medical Sciences, 6(10), 491.

Tamariz, L., Eng, J., Segal, J., Krishnan, J., Bolger, D., & Streiff, M.,…Bass, E. B. (2004). Usefulness of Clinical Prediction Rules for the Diagnosis of Venous Thromboembolism: A Systematic Review. The American Journal Of Medicine117(9), 676-684.

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