The Efficiency of Hamilton Pretest Probability Value in Diagnosing Deep Vein Thrombosis
Clinical Medicine Research
Volume 4, Issue 2, March 2015, Pages: 43-49
Received: Jan. 29, 2015; Accepted: Feb. 19, 2015; Published: Mar. 3, 2015
Views 2701      Downloads 134
Starry Homenta Rampengan, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
Article Tools
Follow on us
Deep vein thrombosis (DVT) is a condition, in which an obstruction of blood flow in veins is found due to the formation of blood clots in the deep veins. An objective diagnosis of DVT is based on ultrasonography examination. However, in poor countries, including Indonesia, many hospitals still do not have the facilities of ultrasonography, less vascular specialists, or D-dimer examination and therefore, to establish the diagnosis of DVT they only can rely on history taking and physical examination. To find out whether the high Hamilton PPS can be used to diagnosis of DVT and whether the high Hamilton score the greater the possibility for DVT, and to know it sensitivity and specificity. A cross-sectional study was done, which was conducted to identify the reliability (sensitivity and specificity) of Hamilton PPS in establishing DVT diagnosis. The study used the Color Duplex Sonography (CDS) for extremity veins as the gold standard. We enrolled 193 patients with probability of DVT. Hamilton PPS and extremity veins CDS were done and tabulation was performed and data was analyzed statistically. Data analysis for testing was performed by the logistic regression analysis and Receiver Operating Characteristic curve using a computer software program of SPSS version 17.0. Hamilton score has sensitivity 0.8, specificity 0.85, accuracy of value 0.84 and positive predictive value 0.63, negative predictive value 0.93.The correlation between Hamilton score and sonography to diagnosis of DVT is positive with the sensitivity and specificity of Hamilton score is ≥ 80 %.
Color Duplex Sonography, Deep Vein Thrombosis, Extremity Veins, Hamilton Score, Sensitivity, Specificity
To cite this article
Starry Homenta Rampengan, The Efficiency of Hamilton Pretest Probability Value in Diagnosing Deep Vein Thrombosis, Clinical Medicine Research. Vol. 4, No. 2, 2015, pp. 43-49. doi: 10.11648/j.cmr.20150402.14
Scarvelis D, Wells PS. Diagnosis and treatment of deep-vein thrombosis. CMAJ 2006; 175(9):1087-92
James AH. Venous Thromboembolism in Pregnancy. Arterioscler Thromb Vasc Biol. 2009;29:326-31
Lapner ST, Kearon C. Diagnosis and management of pulmonary embolism. BMJ 2013;346: f757
Larson L, Mehta N, Miller M. Venous thromboemblic disease and pregnancy. N Engl J Med 2009;360:638-40
Braekkan SK, Mathlesen EB, Njelstad I, et al. Hematocrit and risk of venous and thromboembolism in a general population. The Tromso study. Haematologica 2010;95:270-75
Bates SM, Ginsberg JS. Treatment of deep-vein thrombosis. N Engl J Med 2004;351:268-77
Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD, et al. Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e351S-418S
Francis CW. Prophylaxis for thromboembolism in hospitalized medical patients. N Engl J Med 2007;356:1438-44
Hunt BJ. Grecr I. Low molecular weight heparin in pregnancy: current issues. British J of Haem 2004;128:593-601
Mandala` M, Falanga A, Roila F. Management of venous thromboembolism (VTE) in cancer patients: ESMO Clinical Practice Guidelines. Annals of Oncology 2011; 22 (Suppl 6): vi85–vi92
Cushman M. Epidemiology and Risk Factors for Venous Thrombosis. Semin Hematol 2007; 44(2):62–9.
Goldhaber SZ. Venous thromboembolism: Epidemiology and magnitude of the problem. Best Practice & Research Clinical Haematology 2012; 25 (3): 235–42
Blom JW, Osanto S, Rosendaal FR. High risk of venous thrombosis in patients with pancreatic cancer: A cohort study of 202 patients. Eur J Cancer 2006;42:410-14
McDonald DM, Yao LC, Baluk P. Dynamics of airway blood vessels and lymphatics: lessons from development and inflammation. Proc Am Thorac Soc 2011;8(6):504-7
Cheng A, Scholtt DW. Care of hospitalized patient. In: Cheng A, Zaas A. The Osler Medical Handbook. The Curtis Center, Philadelphia.2004:57-63
Longmore M, Rajagopalan S, Wilkinson I. Deep vein thrombosis. In: Oxford Handbook of Clinical Medicine. 6st ed. Oxford University Press, New York. 2004:456-457
Andritsos L, Eby C, Yusen RD. Disorders of hemostatis. In: The Washington Manual of Medical Therapeutics. 3st ed. Lippincott Williams dan Wilkins, Washington. 2004;398-422
Rizal ADI. Pengaruh pemberian heparin intravena sebagai profilaksis deep vein thrombosis terhadap kadar fibrinogen. Undip Semarang, 2012
Subramaniam RM, Chou T, Heath R, et al. Importance of pretest probability score and D-dimer assay before sonography for lower limb deep venous thrombosis. AJR 2006;186:206-12
Hunt Dan. Determining the clinical probability of deep venous thrombosis and pulmonary embolism. Southern Med J 2007;100:1015-20
Mal S, Mensah A, Smith C, et al. Is pretest probability assesment on emergency departmen patients with suspected venous thromboembolism documented before Simpli RED D-dimer testing?. N Engl J Med 2008;10:519-23
Setiabudy RD. Pemeriksaan laboratorium pada thrombosis vena dalam. In: Setiabudy RD (ed). Hemostatis dan thrombosis. Edisi IV. Balai Penerbit FKUI, Jakarta. 2009:66-77
Heath R, Sleigh J, Subramaniam RM, et al. Diagnosis of lower limb deep venous thrombosis in emergency department patients: performance of Hamilton and modified Wells scores. Annals of Emergency Med 2006;48:678-85
Cosmi B, Legnani C, Paraleti G, et al. D-Dimer testing to determine the duration of anicoagulation therapy. N Engl J Med 2006;355:1780-9
Sukrisman L. Trombosis vena dalam dan emboli paru. In: Sudoyo AW, Setiyohadi B, Alwi I (eds). Buku Ajar Ilmu Penyakit Dalam. Edisi IV. Balai Penerbit FKUI, Jakarta. 2006; 802-4
Setiabudy RD, Sutanto I. Hubungan antara kelainan laboratorium dengan trombosis. Dalam: setabudy RD (ed). Hemostatis. Edisi IV. Balai Penerbit FKUI, Jakarta. 2009;48-54
Scarvelis D, Wells PS. Diagnosis and treatment of deep-vein thrombosis. CMAJ 2006; 175( 9):1087-92
Bates. Treatment of deep-vein thrombosis. N Eng J Med 2004;351:268-77
Setiabudy RD. Patofisiologi thrombosis. In: Setiabudy RD (ed). Hemostatis dan trombosis. Edisi IV. Balai Penerbit FKUI, Jakarta. 2009:34-47
Prasad V, Rho J, Cifu A. The diagnosis and treatment of pulmonary embolism: a metaphor for medicine in the evidence-based medicine era. Arch Intern Med 2012;172(12): 955-8
Buller HR, Cohen AT, Davidson B, et al. Idraparinux versus standart therapy for venous thromboembolic disease. N Engl J Med 2007;357:1094-104
Hartono F, Ismail HD. Insidensi Trombosis Vena dalam Pasca Operasi Orthopedi Risiko Tinggi Tanpa Tromboprofilaksis. J Indon Med Assoc 2011; 61(6): 258-261
Brenner B, Dahl OE, Kakkar AK, et al. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous tromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet 2008;367: 668-78
Keeling D, Mackie I, Moore GW, Greer IA, Greaves M and British Committee for Standards in Haematology. Guidelines on the investigation and management of antiphospholipid syndrome. BJH 2012;157:47–58
Schierbeck LL, Rejnmark L, Tofteng CL, Stilgren L, Eiken P, Mosekilde L, et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ 2012;345:e6409
Wells PS, Forgie MA, Rodger MA. Treatment of Venous Thromboembolism. JAMA 2014;311(7):717-28
Büller HR, Décousus H, Grosso MA, Mercuri M, Middeldorp S, Prins MH, et al. Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism. N Engl J Med 2013;369:1406-15
Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous Thromboembolism. Am J Prev Med 2010;38(4S): S495–S501
Prandoni P. Venous thromboembolism and atherosclerosis: is there a link?. J Thromb Haemost 2007;5(Suppl 1):270-5
Israr, YA. Trombosis. Faculty of Medicine University of Riau. Pekanbaru, Riau, 2009
Handin Robert I. Disorders of coagulation and thrombosis. In: Braunwald E, fauci AS, Kasper DL, et al (eds). Harrison’s Principle of Internal Medicine. 16th ed. Vol I. Mc Graw-Hill Inc, New York. 2005:680-87
Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(Suppl 2):e419S-94S
Creager MA, Dzau VJ. Vascular disease of the extremities. In: Braunwald E, fauci AS, Kasper DL, et al (eds). Harrison’s Principle of Internal Medicine. 16th ed. Vol I. Mc Graw-Hill Inc, New York. 2005:1486-94
Moser KM. Venous thromboembolism. In: Marino paul L (ed). The ICU Book. 3rd ed. Lippincott Williams and Walkins, New York. 2007:81-103
Lyman GH, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, Balaban EP, et al. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2013;31:2189-204
Buckup K. Venous thrombosis. In: Clinical test for the musculoskeletal system. Klinikum Dortmund, Stuggard. 2004:246-50
Streiff MB, Brady PJ, Grant AM, Grosse SD, Wong B, Popovic T. CDC Grand Rounds: Preventing Hospital-Associated Venous Thromboembolism. Weekly 2014;63(09); 190-3
Oemar H. Pengenalan ekokardiografi dan prinsip dasar. In: Textbook of Echocardiography: Interpretasi dan diagnosis klinik. YMB, Jakarta. 2005: 1-41
Setiabudy RD. Aplikasi D-Dimer di klinik. Informasi Laboratorium Prodia 2009:4: 1-3
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186