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Ruud Oudega

Publications and source records attributed to Ruud Oudega.

7 recordsLinked to original sources
PubMed2006

The value of clinical findings and D-dimer tests in diagnosing deep vein thrombosis in primary care.

In primary care, the physician has to decide which patients with a suspicion of deep vein thrombosis (DVT) have to be referred for further diagnostic work-up. Accurate referral is of utmost importance because unrecognized and therefore untreated DVT may cause pulmonary embolism. The classic clinical findings are not sufficiently accurate for the diagnosis of DVT. The majority of the referred patients, 70 to 80%, do not have DVT and this puts a burden on both patients and health care budgets. Diagnosis in primary care is different from that in secondary care caused by the referral mechanism or spectrum difference. Diagnostic tests derived in secondary care, therefore, cannot simply be generalized to primary-care patients. The well-known diagnostic rule for DVT, the Wells rule, does not adequately rule out DVT in primary-care patients. A proper diagnostic rule for use in primary care is lacking; therefore, we investigated the data of 1,295 patients in primary care suspected of having DVT. We developed and validated a simple diagnostic decision rule to exclude the presence of DVT safely in primary care. Independent diagnostic indicators of the presence of DVT were male gender, oral contraceptive use, presence of malignancy, recent surgery, absence of leg trauma, vein distension, calf circumference difference, and D-dimer test result. Application of this rule could reduce the number of referrals by at least 23%, whereas only 0.7% of the patients with a DVT would not be referred. A diagnosis strategy is given, together with a practical flow diagram.

Female↗
PubMed2006

Deep vein thrombosis in primary care: possible malignancy?

BACKGROUND: The increased prevalence of unrecognised malignancy in patients with deep vein thrombosis (DVT) has been well established in secondary care settings. However, data from primary care settings, needed to tailor the diagnostic workup, are lacking. AIM: To quantify the prevalence of unrecognised malignancy in primary care patients who have been diagnosed with DVT. DESIGN: Prospective follow-up study. SETTING: All primary care physicians affiliated/associated with a non-teaching hospital in a geographically circumscribed region participated in the study. METHOD: A total of 430 consecutive patients without known malignancy, but with proven DVT were included in the study and compared with a control group of 442 primary care patients, matched according to age and sex. Previously unrecognised, occult malignancy was considered present if a new malignancy was diagnosed within 2 years following DVT diagnosis (DVT group) or inclusion in the control group. Patients with DVT were categorised in to those with unprovoked idiopathic DVT and those with risk factors for DVT (that is, secondary DVT). RESULTS: During the 2-year follow-up period, a new malignancy was diagnosed 3.6 times more often in patients with idiopathic DVT than in the control group (2-year incidence: 7.4% and 2.0%, respectively). The incidence in patients with secondary DVT was 2.6%; only slightly higher than in control patients. CONCLUSION: Unrecognised malignancies are more common in both primary and secondary care patients with DVT than in the general population. In particular, patients with idiopathic DVT are at risk and they could benefit from individualised case-finding to detect malignancy.

Case-Control Studies↗
PubMed2005

The Wells rule does not adequately rule out deep venous thrombosis in primary care patients.

BACKGROUND: Using data from secondary care outpatients, Wells and colleagues developed a diagnostic rule to estimate the probability of the presence of deep venous thrombosis (DVT). The accuracy of the Wells rule has not been properly validated for use in primary care patients in whom DVT is suspected. OBJECTIVE: To validate the diagnostic accuracy of the Wells rule, with and without D-dimer testing, in a primary care setting. DESIGN: Cross-sectional study with prospective data collection from 1 January 2002 to 1 March 2003. SETTING: 110 primary care practices in a circumscribed geographic region in The Netherlands. PARTICIPANTS: 1295 consecutive patients who consulted their primary care physician about symptoms suggestive of DVT. MEASUREMENTS: All patients underwent history-taking and physical examination to calculate the Wells rule score, and D-dimer testing. Repeated leg ultrasonography was the reference standard to determine the true presence or absence of DVT. RESULTS: In the primary care setting, 12.0% of patients in the low-risk group had DVT; the original study by Wells and colleagues reported a rate of 3% among such patients. When combined with negative results on a D-dimer test, the Wells rule yielded a prevalence of DVT of 2.9% in the lowest-risk group, whereas the prevalence was 0.9% in the original study. LIMITATIONS: Patients with previous DVT were included, and the diagnostic reference standard was different from that used in Wells and colleagues' original study. CONCLUSION: The Wells rule, alone or in combination with D-dimer testing, does not guarantee accurate estimation of risk in primary care patients in whom DVT is suspected.

Adult↗
PubMed2005

Limited value of patient history and physical examination in diagnosing deep vein thrombosis in primary care.

BACKGROUND: Properly ruling in or out deep vein thrombosis (DVT) is important because of the risk of developing pulmonary embolism if untreated and the risk of bleeding when treated with anticoagulants. In primary care, the diagnosis in suspected DVT is non-specific and the physician has to decide which patients to refer for further diagnostic work-up on the basis of patient history and physical examination alone. OBJECTIVE: To quantify which (combination of) items from patient history and physical examination contribute to the diagnosis of DVT in primary care. METHODS: A cross-sectional study design was chosen and the setting was all primary care physicians adherent to three local hospitals. 1325 consecutive patients consulting their primary care physician with symptoms suggestive of DVT were included. RESULTS: We studied 1325 patients with suspected DVT. The prevalence of thrombosis (assessed by means of compression ultrasonography) in these patients was 29%. Multivariate regression analysis of 17 candidate predictors resulted in nine independent predictors of DVT: male gender, duration of symptoms, malignancy, immobilization, leg trauma, pain when walking, oedema, calf circumference and dilated veins. The predictive value of the combination of the nine independent variables was low, reflected in the ROC area (as a combination of the sensitivity and specificity) of this model of 0.68. The low discriminative value was also exhibited in the numbers of DVT in the different risk categories. For example, in the low-risk group, the probability of DVT was still 15%. The diagnostic performance of patient history and physical examination was similar (and thus poor) in all clinically relevant subgroups. CONCLUSION: Patient history and physical examination in patients suspected of DVT are of limited value for the primary care setting to identify patients with a low or high probability of DVT and thus in the decision to refer for further diagnostic work-up.

Cross-Sectional Studies↗
PubMed2005

Ruling out deep venous thrombosis in primary care. A simple diagnostic algorithm including D-dimer testing.

In primary care, the physician has to decide which patients have to be referred for further diagnostic work-up. At present, only in 20% to 30% of the referred patients the diagnosis DVT is confirmed. This puts a burden on both patients and health care budgets. The question arises whether the diagnostic work-up and referral of patients suspected of DVT in primary care could be more efficient. A simple diagnostic decision rule developed in primary care is required to safely exclude the presence of DVT in patients suspected of DVT, without the need for referral. In a cross-sectional study, we investigated the data of 1295 consecutive patients consulting their primary care physician with symptoms suggestive of DVT, to develop and validate a simple diagnostic decision rule to safely exclude the presence of DVT. Independent diagnostic indicators of the presence of DVT were male gender, oral contraceptive use, presence of malignancy, recent surgery, absence of leg trauma, vein distension, calf difference and D-dimer test result. Application of this rule could reduce the number of referrals by at least 23% while only 0.7% of the patients with a DVT would not be referred. We conclude that by using eight simple diagnostic indicators from patient history, physical examination and the result of D-dimer testing, it is possible to safely rule out DVT in a large number of patients in primary care, reducing unnecessary patient burden and health care costs.

Adult↗