Outcomes in patients with suspected lower extremity DVT from test accuracy studies
| Pathway* . | PTP . | Studies . | All-cause mortality . | Mortality from VTE at 3 mo . | Incidence of PE at 3 mo . | Incidence of DVT at 3 mo . | Overall VTE at 3 mo . | Postthrombotic syndrome . | Major bleeding . | Intracranial hemorrhage . |
|---|---|---|---|---|---|---|---|---|---|---|
| Anticoagulated (TP/FP population) | ||||||||||
| B | Low | Positive compression US | 0/18 (0%) | 0/18 (0%) | 0/18 (0%) | 0/18 (0%) | 0/18 (0%) | 0/18 (0%) | 0/18 (0%) | 0/18 (0%) |
| A, E | Low | Positive compression US alone or positive serial US after initial compression US | 7/84 (8.33%; 95% CI, 2.42%-14.24%) | 0/84 (0%) | 0/79 (0%) | 4/79 (5.06%; 95% CI, 0.23%-9.90%) | 4/79 (5.06%; 95% CI, 0.23%-9.90%) | 0/14 (0%) | 0/14 (0%) | 0/14 (0%) |
| H | Low | Positive DD → positive US | 5/80 (6.25%; 95% CI, 0.95%-11.55%) | 0/80 (0%) | 0/80 (0%) | 0/80 (0%) | 0/80 (0%) | NR | NR | NR |
| G | Low | Positive DD | NR | 0/202 (0%) | 0/202 (0%) | 0/202 (0%) | 0/202 (0%) | 0/202 (0%) | 0/202 (0%) | 0/202 (0%) |
| B | High | Positive compression US | 2/24 (8.33%; 95% CI, 0%-19.39%) | 0/24 (0%) | 0/24 (0%) | 0/24 (0%) | 0/24 (0%) | 0/24 (0%) | 0/24 (0%) | 0/24 (0%) |
| G | High | Positive DD | NR | 0/68 (0%) | 0/68 (0%) | 0/68 (0%) | 0/68 (0%) | 0/68 (0%) | 0/68 (0%) | 0/68 (0%) |
| Overall positive for DVT and initiated on anticoagulation | 6.79%; 95% CI, 3.36%-10.23% (14/206) | 0% (0/476) | 0% (0/471) | 0.85% 95% CI, 0%-2.10%) (4/471) | 0.85%; 95% CI, 0%-2.10%) (4/471) | 0% (0/326) | 0% (0/326) | 0% (0/326) | ||
| Not anticoagulated (TN/FN population) | ||||||||||
| B | Low | Negative compression US | 10/612 (1.63%; 95% CI 0.63%-2.64%) | 0/884 (0%) | 5/884 (0.57%; 95% CI, 0.07%-1.06%) | 10/884 (1.13%; 95% CI, 0.43%-1.83%) | 15/884 (1.70%; 95% CI, 0.89%-2.67%) | 0/277 (0%) | 0/277 (0%) | 0/277 (0%) |
| A, E | Low | Negative compression US or negative serial US after initial compression US | 8/426 (1.88%; 95% CI, 0.59%-3.17%) | 0/1212 (0%) | 3/1212 (0.25%; 95% CI, 0%-0.53%) | 6/1212 (0.50%; 95% CI, 0.10%-0.89%) | 9/1212 (0.74%; 95% CI, 0.26%-1.23%) | 0/91 (0%) | 0/91 (0%) | 0/91 (0%) |
| G | Low | Negative DD | 0/120 (0%) | 0/338 (0%) | 0/338 (0%) | 2/338 (1.03%; 95% CI 0%-1.41%) | 2/338 (1.03%; 95% CI 0%-1.41%) | 0/120 (0%) | 0/120 (0%) | 0/120 (0%) |
| H | Low | Positive DD → negative compression US | NR | 0/85 | 0/85 (0%) | 0/85 (0%) | 0/85 (0%) | NR | NR | NR |
| B | Intermediate | Negative compression US | NR | 0/363 (0%) | 2/363 (0.55%; 95% CI, 0%-1.31%) | 4/363 (1.10%; 95% CI 0.03%-2.18%) | 6/363 (1.65%; 95% CI, 0.34%-2.96%) | NR | NR | NR |
| A | Intermediate | Negative whole leg US | 2/154 (1.30%; 95% CI, 0%-2.18%) | 0/148 (0%) | 0/148 (0%) | 1/148 (0.68%; 95% CI, 0%-2.0%) | 1/148 (0.68%; 95% CI, 0%-2.0%) | NR | NR | NR |
| G | Intermediate | Negative DD | 0/49 (0%) | 0/49 (0%) | 0/49 (0%) | 2/49 (4.08%; 95% CI 0%-9.62%) | 2/49 (4.08%; 95% CI 0%-9.62%) | NR | NR | NR |
| I | Intermediate | Positive DD → negative whole leg US | NR | NR | 0/464 (0%) | 13/464 (2.80%; 95% CI, 1.30%-4.30%) | 13/464 (2.80%; 95% CI, 1.30%-4.30%) | NR | NR | NR |
| C, D | Intermediate | Negative compression US → negative DD | 4/598 (0.67%; 95% CI, 0.02%-1.32%) | 0/679 (0%) | 0/679 (0%) | 1/679 (0.15%; 95% CI, 0%-0.44%) | 1/679 (0.15%; 95% CI, 0%-0.44%) | NR | NR | NR |
| D | Intermediate | Negative compression US → positive DD → negative serial US | 1/83 (1.20%; 95% CI, 0%-3.55%) | 1/180 (0.56%; 95% CI, 0%-1.64%) | 2/180 (1.11%; 95% CI; 0%-2.64%) | 0/180 (0%) | 2/180 (1.11%; 95% CI; 0%-2.64%) | NR | NR | NR |
| B | High | Negative compression US | 0/25 (0%) | 0/25 (0%) | 0/29 (0%) | 4/29 (13.8%; 95% CI 1.24%-26.34%) | 4/29 (13.8%; 95% CI 1.24%-26.34%) | 0/29 (0%) | 0/29 (0%) | 0/29 (0%) |
| G | High | Negative DD | 0/11 (0%) | 0/11 (0%) | 0/11 (0%) | 0/11 (0%) | 0/11 (0%) | 0/11 (0%) | 0/11 (0%) | 0/11 (0%) |
| Pathway* . | PTP . | Studies . | All-cause mortality . | Mortality from VTE at 3 mo . | Incidence of PE at 3 mo . | Incidence of DVT at 3 mo . | Overall VTE at 3 mo . | Postthrombotic syndrome . | Major bleeding . | Intracranial hemorrhage . |
|---|---|---|---|---|---|---|---|---|---|---|
| Anticoagulated (TP/FP population) | ||||||||||
| B | Low | Positive compression US | 0/18 (0%) | 0/18 (0%) | 0/18 (0%) | 0/18 (0%) | 0/18 (0%) | 0/18 (0%) | 0/18 (0%) | 0/18 (0%) |
| A, E | Low | Positive compression US alone or positive serial US after initial compression US | 7/84 (8.33%; 95% CI, 2.42%-14.24%) | 0/84 (0%) | 0/79 (0%) | 4/79 (5.06%; 95% CI, 0.23%-9.90%) | 4/79 (5.06%; 95% CI, 0.23%-9.90%) | 0/14 (0%) | 0/14 (0%) | 0/14 (0%) |
| H | Low | Positive DD → positive US | 5/80 (6.25%; 95% CI, 0.95%-11.55%) | 0/80 (0%) | 0/80 (0%) | 0/80 (0%) | 0/80 (0%) | NR | NR | NR |
| G | Low | Positive DD | NR | 0/202 (0%) | 0/202 (0%) | 0/202 (0%) | 0/202 (0%) | 0/202 (0%) | 0/202 (0%) | 0/202 (0%) |
| B | High | Positive compression US | 2/24 (8.33%; 95% CI, 0%-19.39%) | 0/24 (0%) | 0/24 (0%) | 0/24 (0%) | 0/24 (0%) | 0/24 (0%) | 0/24 (0%) | 0/24 (0%) |
| G | High | Positive DD | NR | 0/68 (0%) | 0/68 (0%) | 0/68 (0%) | 0/68 (0%) | 0/68 (0%) | 0/68 (0%) | 0/68 (0%) |
| Overall positive for DVT and initiated on anticoagulation | 6.79%; 95% CI, 3.36%-10.23% (14/206) | 0% (0/476) | 0% (0/471) | 0.85% 95% CI, 0%-2.10%) (4/471) | 0.85%; 95% CI, 0%-2.10%) (4/471) | 0% (0/326) | 0% (0/326) | 0% (0/326) | ||
| Not anticoagulated (TN/FN population) | ||||||||||
| B | Low | Negative compression US | 10/612 (1.63%; 95% CI 0.63%-2.64%) | 0/884 (0%) | 5/884 (0.57%; 95% CI, 0.07%-1.06%) | 10/884 (1.13%; 95% CI, 0.43%-1.83%) | 15/884 (1.70%; 95% CI, 0.89%-2.67%) | 0/277 (0%) | 0/277 (0%) | 0/277 (0%) |
| A, E | Low | Negative compression US or negative serial US after initial compression US | 8/426 (1.88%; 95% CI, 0.59%-3.17%) | 0/1212 (0%) | 3/1212 (0.25%; 95% CI, 0%-0.53%) | 6/1212 (0.50%; 95% CI, 0.10%-0.89%) | 9/1212 (0.74%; 95% CI, 0.26%-1.23%) | 0/91 (0%) | 0/91 (0%) | 0/91 (0%) |
| G | Low | Negative DD | 0/120 (0%) | 0/338 (0%) | 0/338 (0%) | 2/338 (1.03%; 95% CI 0%-1.41%) | 2/338 (1.03%; 95% CI 0%-1.41%) | 0/120 (0%) | 0/120 (0%) | 0/120 (0%) |
| H | Low | Positive DD → negative compression US | NR | 0/85 | 0/85 (0%) | 0/85 (0%) | 0/85 (0%) | NR | NR | NR |
| B | Intermediate | Negative compression US | NR | 0/363 (0%) | 2/363 (0.55%; 95% CI, 0%-1.31%) | 4/363 (1.10%; 95% CI 0.03%-2.18%) | 6/363 (1.65%; 95% CI, 0.34%-2.96%) | NR | NR | NR |
| A | Intermediate | Negative whole leg US | 2/154 (1.30%; 95% CI, 0%-2.18%) | 0/148 (0%) | 0/148 (0%) | 1/148 (0.68%; 95% CI, 0%-2.0%) | 1/148 (0.68%; 95% CI, 0%-2.0%) | NR | NR | NR |
| G | Intermediate | Negative DD | 0/49 (0%) | 0/49 (0%) | 0/49 (0%) | 2/49 (4.08%; 95% CI 0%-9.62%) | 2/49 (4.08%; 95% CI 0%-9.62%) | NR | NR | NR |
| I | Intermediate | Positive DD → negative whole leg US | NR | NR | 0/464 (0%) | 13/464 (2.80%; 95% CI, 1.30%-4.30%) | 13/464 (2.80%; 95% CI, 1.30%-4.30%) | NR | NR | NR |
| C, D | Intermediate | Negative compression US → negative DD | 4/598 (0.67%; 95% CI, 0.02%-1.32%) | 0/679 (0%) | 0/679 (0%) | 1/679 (0.15%; 95% CI, 0%-0.44%) | 1/679 (0.15%; 95% CI, 0%-0.44%) | NR | NR | NR |
| D | Intermediate | Negative compression US → positive DD → negative serial US | 1/83 (1.20%; 95% CI, 0%-3.55%) | 1/180 (0.56%; 95% CI, 0%-1.64%) | 2/180 (1.11%; 95% CI; 0%-2.64%) | 0/180 (0%) | 2/180 (1.11%; 95% CI; 0%-2.64%) | NR | NR | NR |
| B | High | Negative compression US | 0/25 (0%) | 0/25 (0%) | 0/29 (0%) | 4/29 (13.8%; 95% CI 1.24%-26.34%) | 4/29 (13.8%; 95% CI 1.24%-26.34%) | 0/29 (0%) | 0/29 (0%) | 0/29 (0%) |
| G | High | Negative DD | 0/11 (0%) | 0/11 (0%) | 0/11 (0%) | 0/11 (0%) | 0/11 (0%) | 0/11 (0%) | 0/11 (0%) | 0/11 (0%) |
Total of 9 studies,13-21 5126 patients.
DD, D-dimer; NR, not reported.
Pathways labeled by letter available with diagrams in supplemental Material 1.