The article authored by Toll et al. (2008) described the efficiency of the current diagnostic criteria for referring patients with possible deep vein thrombosis (DVT). This research was launched as a response to the recent directive of the American Academy of Family Physicians, as well as the American College of Physicians, to follow a list of criteria in diagnosing DVT in patients. The two medical associations presented this list of criteria as a predictive tool that could be adapted by physicians in determining whether a patient indeed suffers from DVT.
The predictive tool, as known as the Wells rule, was earlier validated among patients and may thus be employed by physicians (Wells et al. , 2003). The investigators of this research article wanted to determine whether the Wells rule can be safely applied to the primary care setting. Technically, the Wells rule follows a distinct set of criteria that allows a physician to determine the risk level of a particular patient for DVT. The outcome of the Wells rule thus involves the reduction of unnecessary referrals of patients for procedures such as ultrasonography.
In addition, the patient is also prevented from dealing with needless procedures, which also may pose as an additional source of stress to a patient. The investigators were thus prompted to determine the efficiency of the Wells rule in different types of patients, which are generally observed in the primary care setting. In general, primary care physicians attend to various kinds of patients and thus the Wells rule may or may not be specific or efficient enough for application in this kind of setting. This investigation was thus conducted by the authors, in order to determine the usefulness of the Wells rule.
Any results that would be generated from this research effort would benefit both primary care physicians, as well as the patients who consult these medical professionals. On the part of primary care physicians, it would be helpful for these professionals to determine whether the Wells rule is indeed a reliable tool for their practice. On the part of the patients, any avoidable test would decrease the chances of these individuals to experience additional burden, stress and expenses. The authors pointed out four main points that need to be addressed in their study. Firstly, DVT is known to occur at a high degree among older individuals.
It is thus pertinent to determine whether the Wells rule considers such increase in susceptibility among different age groups. Secondly, DVT is often observed as a co-morbidity and so far, the Wells rule does not address this association. Another point of the investigation is that the D-dimer test, the main procedure that determines the condition of DVT, losses its specificity in elderly patients. Such observation thus poses a risk in the efficiency of the Wells rule, as most of the patients are known to be of senior age. The authors are also aware that the Wells rule is not sensitive enough among elderly individuals.
In order to address these questions, the investigators conducted an analysis of approximately 2,086 patients from three primary care clinics who were suspected to have developed DVT. The main criterion for inclusion to the study was the presence of swelling in the legs of the patients that lasted for less than 30 days. The patients were then subjected to undergo the D-dimer test and the results were thus classified into two groups. Patients with D-dimer test results with equal to or less than 3. 0 were classified as low-risk, while those with results equal to or higher than 4. 0 were classified as high-risk.
The generated classification was then compared to other factors, such as age and sex. The results of the study showed that the D-dimer cut-off score of 3. 0 may be confusing when the patient is above 50 years of age. The investigators thus suggested that a cut-off score of 4. 0 or 5. 0 is therefore more efficient among elderly patients. The basis of this recommendation was observed when the patients were classified according to age ranges. The study also showed that the Wells rule is efficient enough when applied to younger patients, but may not be so reliable anymore when a patient is at least 50 years old.
The argument of this research report is logical as they expressed their concern over the reliability and efficiency of the Wells rule in predicting the occurrence of DVT among patient. The research report was well presented, as the authors enumerated the points that were intended to be addressed by their research study. Their results were also clearly explained and highly accurate in terms of statistical analysis and significance. Based on the results presented in the research article, the arguments of the investigators support the main theme of determining the efficiency and safety of the Wells rule in predicting DVT among patients.
The investigators have effectively pointed out the importance of their study, as they enumerated the main points that need to be assessed in the Wells rule. The research report has also effectively presented the problem of applicability of the prediction tool in terms of variations among patients. On a personal note, this research report is very important because it critically looks into the strengths and weaknesses of a specific diagnostic criterion, in the form of the D-dimer test.
The research report allows physicians to be aware that every diagnostic tool should be conducted with some caution, especially when being applied in the primary care setting. Evidence-based practice allows physicians and other healthcare professionals to determine the best methods in addressing and treating specific medical conditions. This practice is mainly based on actual medical reports, including the outcome of specific tests on a number of patients. Any observations are integrated into a diagnostic tool and disseminated to the rest of the medical community.
The importance of evidence-based practice, such as the report on the efficiency of the Wells rule, will thus provide additional information that would facilitate in modifying the diagnostic procedure for DVT.
Reference Toll, D. B. , Oudega, R. , Vergouwe, Y. , Moons, K. G. M. and Hoes, A. W. (2008). A new diagnostic rule for deep vein thrombosis: Safety and efficiency in clinically relevant subgroups. Family Practice, 25, 3–8. Wells, P. S. , Anderson, D. R. and Rodger, M. (2003). Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. New England Journal of Medicine, 349, 1227–1235.