Outcomes in patients with suspected upper extremity DVT from test accuracy studies
| Pathway* . | PTP . | Studies . | Mortality: all cause . | Mortality: from UE DVT at 3 mo . | PE at 3 mo . | Mortality: from PE at 3 mo . | UE DVT at 3 mo . | Overall VTE at 3 mo . | Post thrombotic syndrome . | Major bleeding . | Intracranial hemorrhage . |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Anticoagulated (TP/FP population) | |||||||||||
| E | Unlikely | Positive DD | 2/203 (0.99%; 95% CI, 0%-2.34%) | 0/112 (0%) | 0/112 (0%) | 0/112 (0%) | 0/112 (0%) | 0/112 (0%) | NR | NR | NR |
| F | Unlikely | Positive DD → Positive US | 2/203 (0.99%; 95% CI, 0.37%-2.34%) | 0/37 (0%) | 0/37 (0%) | 0/37 (0%) | 0/37 (0%) | 0/37 (0%) | NR | NR | NR |
| A | Likely | Positive US | 10/261 (3.83%; 95% CI,1.50%- 6.16%) | 0/144 (0%) | 8/137 (5.84%; 95% CI, 1.91%-9.76%) | 0/173 (0%) | 2/142 (1.41%; 95% CI,0%-3.34%) | 10/142 (7.04%; 95% CI, 2.83%-11.25%) | 0/58 (0%) | NR | NR |
| D | Likely | Positive US or Negative US → positive DD → positive serial US | 5/203 (2.46%; 95% CI, 0.33%-4.59%) | 0/119 (0%) | 0/119 (0%) | 0/119 (0%) | 0/119 (0%) | 0/119 (0%) | NR | NR | NR |
| Overall positive for DVT and initiated on anticoagulation | 1.03%; 95% CI, 0.36%- 1.71% (9/870) | 0% (0/412) | 1.98%; 95% CI, 0.62%-3.33% (8/405) | 0% (0/441) | 0.49%; 95% CI, 0%-1.16% (2/410) | 2.44%; 95% CI, 0.95%-3.93% (10/410) | 0% (0/58) | NR | NR | ||
| Not anticoagulated (TN/FN population) | |||||||||||
| E | Unlikely | Negative DD | 0/117 (0%) | 0/204 (0%) | 0/204 (0%) | 0/204 (0%) | 2/204 (0.98%; 95% CI, 0%-2.33%) | 2/204 (0.98%; 95% CI, 0%-2.33%) | 0/117 (0%) | NR | NR |
| A | Unlikely | Negative US | 0/182 (0%) | 0/182 (0%) | 0/182 (0%) | 0/182 (0%) | 3/182 (1.65%;95% CI, 0%-3.49%) | 3/182 (1.65%;95% CI, 0%-3.49%) | 0/182 (0%) | NR | NR |
| B | Unlikely | Negative US → and negative serial US | 0/180 (0%) | 0/180 (0%) | 0/180 (0%) | 0/180 (0%) | 1/180 (0.56%; 95% CI, 0%-1.64%) | 1/180 (0.56%; 95% CI, 0%-1.64%) | 0/180 (0%) | NR | NR |
| F | Unlikely | Negative DD or Positive DD → negative US | 2/203 (0.99%; 95% CI, 0%-2.34%) | 0/162 (0%) | 0/162 (0%) | 0/162 (0%) | 0/162 (0%) | 0/162 (0%) | NR | NR | NR |
| A | Likely | Negative US | 10/261 (3.83%; 95% CI, 1.50%-6.16%) | 0/119 (0%) | 0/119 (0%) | 0/119 (0%) | 5/119 (4.20%; 95% CI, 0.59%-7.80%) | 5/119 (4.20%; 95% CI, 0.59%-7.80%) | 0/58 (0%) | NR | NR |
| D | Likely | Negative US → positive DD → negative serial US | 5/203 (2.46%; 95% CI, 0.33%-4.59%) | 0/84 (0%) | 0/84 (0%) | 0/84 (0%) | 1/84 (1.19%; 95% CI, 0%-3.50%) | 1/84 (1.19%; 95% CI, 0%-3.50%) | NR | NR | NR |
| Pathway* . | PTP . | Studies . | Mortality: all cause . | Mortality: from UE DVT at 3 mo . | PE at 3 mo . | Mortality: from PE at 3 mo . | UE DVT at 3 mo . | Overall VTE at 3 mo . | Post thrombotic syndrome . | Major bleeding . | Intracranial hemorrhage . |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Anticoagulated (TP/FP population) | |||||||||||
| E | Unlikely | Positive DD | 2/203 (0.99%; 95% CI, 0%-2.34%) | 0/112 (0%) | 0/112 (0%) | 0/112 (0%) | 0/112 (0%) | 0/112 (0%) | NR | NR | NR |
| F | Unlikely | Positive DD → Positive US | 2/203 (0.99%; 95% CI, 0.37%-2.34%) | 0/37 (0%) | 0/37 (0%) | 0/37 (0%) | 0/37 (0%) | 0/37 (0%) | NR | NR | NR |
| A | Likely | Positive US | 10/261 (3.83%; 95% CI,1.50%- 6.16%) | 0/144 (0%) | 8/137 (5.84%; 95% CI, 1.91%-9.76%) | 0/173 (0%) | 2/142 (1.41%; 95% CI,0%-3.34%) | 10/142 (7.04%; 95% CI, 2.83%-11.25%) | 0/58 (0%) | NR | NR |
| D | Likely | Positive US or Negative US → positive DD → positive serial US | 5/203 (2.46%; 95% CI, 0.33%-4.59%) | 0/119 (0%) | 0/119 (0%) | 0/119 (0%) | 0/119 (0%) | 0/119 (0%) | NR | NR | NR |
| Overall positive for DVT and initiated on anticoagulation | 1.03%; 95% CI, 0.36%- 1.71% (9/870) | 0% (0/412) | 1.98%; 95% CI, 0.62%-3.33% (8/405) | 0% (0/441) | 0.49%; 95% CI, 0%-1.16% (2/410) | 2.44%; 95% CI, 0.95%-3.93% (10/410) | 0% (0/58) | NR | NR | ||
| Not anticoagulated (TN/FN population) | |||||||||||
| E | Unlikely | Negative DD | 0/117 (0%) | 0/204 (0%) | 0/204 (0%) | 0/204 (0%) | 2/204 (0.98%; 95% CI, 0%-2.33%) | 2/204 (0.98%; 95% CI, 0%-2.33%) | 0/117 (0%) | NR | NR |
| A | Unlikely | Negative US | 0/182 (0%) | 0/182 (0%) | 0/182 (0%) | 0/182 (0%) | 3/182 (1.65%;95% CI, 0%-3.49%) | 3/182 (1.65%;95% CI, 0%-3.49%) | 0/182 (0%) | NR | NR |
| B | Unlikely | Negative US → and negative serial US | 0/180 (0%) | 0/180 (0%) | 0/180 (0%) | 0/180 (0%) | 1/180 (0.56%; 95% CI, 0%-1.64%) | 1/180 (0.56%; 95% CI, 0%-1.64%) | 0/180 (0%) | NR | NR |
| F | Unlikely | Negative DD or Positive DD → negative US | 2/203 (0.99%; 95% CI, 0%-2.34%) | 0/162 (0%) | 0/162 (0%) | 0/162 (0%) | 0/162 (0%) | 0/162 (0%) | NR | NR | NR |
| A | Likely | Negative US | 10/261 (3.83%; 95% CI, 1.50%-6.16%) | 0/119 (0%) | 0/119 (0%) | 0/119 (0%) | 5/119 (4.20%; 95% CI, 0.59%-7.80%) | 5/119 (4.20%; 95% CI, 0.59%-7.80%) | 0/58 (0%) | NR | NR |
| D | Likely | Negative US → positive DD → negative serial US | 5/203 (2.46%; 95% CI, 0.33%-4.59%) | 0/84 (0%) | 0/84 (0%) | 0/84 (0%) | 1/84 (1.19%; 95% CI, 0%-3.50%) | 1/84 (1.19%; 95% CI, 0%-3.50%) | NR | NR | NR |
Total of 3 studies,22-24 500 patients.
Pathways labeled by letter available with diagrams in supplemental Material 1.