What should then be the approach to a patient with suspected DVT?
Because of the low sensitivity and specificity of clinical exam, many authors have tried to either
combine various signs and symptoms (like the Wells’ scoring system for DVT) or have recommended
exclusive reliance on noninvasive tests. Still, five findings seem to be independ-ently and significantly
associated with the presence of proximal DVT: (1) swelling below the knee, (2) swelling above the knee,
(3) recent immobility, (4) cancer, and (5) fever.
Overall, the sensitivity of a positive clinical examination (associated with the presence of one or more of these independent predictors) is 96%, although the specificity is still low (20%). The absence of any of these findings is associated with a less than 5% chance of proximal DVT. Conversely, the presence of two or
more of these clinical findings is associated with a 46% chance of proximal DVT.
Because of the low sensitivity and specificity of clinical exam, many authors have tried to either
combine various signs and symptoms (like the Wells’ scoring system for DVT) or have recommended
exclusive reliance on noninvasive tests. Still, five findings seem to be independ-ently and significantly
associated with the presence of proximal DVT: (1) swelling below the knee, (2) swelling above the knee,
(3) recent immobility, (4) cancer, and (5) fever.
Overall, the sensitivity of a positive clinical examination (associated with the presence of one or more of these independent predictors) is 96%, although the specificity is still low (20%). The absence of any of these findings is associated with a less than 5% chance of proximal DVT. Conversely, the presence of two or
more of these clinical findings is associated with a 46% chance of proximal DVT.