Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Apr 14;4(7):1250-1264.
doi: 10.1182/bloodadvances.2019000960.

Diagnosis of deep vein thrombosis of the lower extremity: a systematic review and meta-analysis of test accuracy

Meha Bhatt  1 , Cody Braun  2 , Payal Patel  3 , Parth Patel  4 , Housne Begum  1 , Wojtek Wiercioch  1 , Jamie Varghese  4 , David Wooldridge  4 , Hani J Alturkmani  4 , Merrill Thomas  4 , Mariam Baig  4 , Waled Bahaj  4 , Rasha Khatib  5 , Rohan Kehar  6 , Rakesh Ponnapureddy  4 , Anchal Sethi  4 , Ahmad Mustafa  4 , Robby Nieuwlaat  1 , Wendy Lim  7   8 , Shannon M Bates  9 , Eddy Lang  10 , Grégoire Le Gal  11 , Marc Righini  12 , Nedaa M Husainat  13 , Mohamad A Kalot  13 , Yazan Nayif Al Jabiri  14 , Holger J Schünemann  1   7 , Reem A Mustafa  1   13
Affiliations
Meta-Analysis

Diagnosis of deep vein thrombosis of the lower extremity: a systematic review and meta-analysis of test accuracy

Meha Bhatt et al. Blood Adv. .

Abstract

Deep vein thrombosis (DVT) of the lower extremities can be associated with significant morbidity and may progress to pulmonary embolism and postthrombotic syndrome. Early diagnosis and treatment are important to minimize the risk of these complications. We systematically reviewed the accuracy of diagnostic tests for first-episode and recurrent DVT of the lower extremities, including proximal compression ultrasonography (US), whole leg US, serial US, and high-sensitivity quantitative D-dimer assays. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. Two investigators screened and abstracted data. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 43 studies. For any suspected DVT, the pooled estimates for sensitivity and specificity of proximal compression US were 90.1% (95% confidence interval [CI], 86.5-92.8) and 98.5% (95% CI, 97.6-99.1), respectively. For whole-leg US, pooled estimates were 94.0% (95% CI, 91.3-95.9) and 97.3% (95% CI, 94.8-98.6); for serial US pooled estimates were 97.9% (95% CI, 96.0-98.9) and 99.8% (95% CI, 99.3-99.9). For D-dimer, pooled estimates were 96.1% (95% CI, 92.6-98.0) and 35.7% (95% CI, 29.5-42.4). Recurrent DVT studies were not pooled. Certainty of evidence varied from low to high. This systematic review of current diagnostic tests for DVT of the lower extremities provides accuracy estimates. The tests are evaluated when performed in a stand-alone fashion, and in a diagnostic pathway. The pretest probability of DVT often assessed by a clinical decision rule will influence how, together with sensitivity and specificity estimates, patients will be managed.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest disclosure: H.J.S. and R.A.M. received research support from American Society of Hematology (ASH), and W.W. received salary support through the ASH grant. The remaining authors declare no competing financial interests.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram for study selection.
Figure 2.
Figure 2.
Pooled sensitivity and specificity of proximal compression ultrasound for diagnosis of lower extremity DVT.
Figure 3.
Figure 3.
Pooled sensitivity and specificity of whole leg ultrasound for diagnosis of lower extremity DVT.
Figure 4.
Figure 4.
Pooled sensitivity and specificity of serial ultrasound for diagnosis of lower extremity DVT.
Figure 5.
Figure 5.
Pooled sensitivity and specificity of D-dimer for diagnosis of lower extremity DVT.
See this image and copyright information in PMC

References

    1. Silverstein MD, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ III. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med. 1998;158(6):585-593. - PubMed
    1. Prandoni P, Lensing AWA, Cogo A, et al. . The long-term clinical course of acute deep venous thrombosis. Ann Intern Med. 1996;125(1):1-7. - PubMed
    1. Landefeld CS, McGuire E, Cohen AM. Clinical findings associated with acute proximal deep vein thrombosis: a basis for quantifying clinical judgment. Am J Med. 1990;88(4):382-388. - PubMed
    1. Kahn SR. The clinical diagnosis of deep venous thrombosis: integrating incidence, risk factors, and symptoms and signs. Arch Intern Med. 1998;158(21):2315-2323. - PubMed
    1. Adam SS, Key NS, Greenberg CS. D-dimer antigen: current concepts and future prospects. Blood. 2009;113(13):2878-2887. - PubMed

Publication types