Summary
Current guidelines recommend optimised algorithms for diagnosis of suspected deep-vein
thrombosis (DVT). There is little data to determine to what extent real-world health
care adheres to guidelines, and which outcome in terms of diagnostic efficiency and
safety is achieved. This registry involved patients with clinically suspected DVT
of the leg recruited in German ambulatory care between October and December 2005.
Registry items were: diagnostic methods applied; diagnostic categories at day 1; and
venous thromboembolic events up to 90 days in patients without firmly established
DVT. A total of 4,976 patients were recruited in 326 centres. Venous ultrasonography
was performed in 4,770 patients (96%), D-dimer assay in 1,773 patients (36%) and venography
in 288 patients (6%). At day 1, DVT was confirmed in 1,388 patients (28%), and ruled
out in 3,389 patients (68%), and work-up was inconclusive in 199 patients (4%).The
rate of venous thromboembolism at 90 days was 0.34% (95% confidence interval [CI]:
0.09 to 0.88) in patients in whom the diagnosis of DVT had been ruled out, and 2.50%
(95% CI: 0.69 to 6.28) in patients with inconclusive diagnostic workup. This nationwide
evaluation in German ambulatory care revealed that the diagnostic work-up for suspected
DVT did not adhere to current guidelines. However, the overall diagnostic safety was
excellent, although there is potential for improvement in a well defined minority
of patients.
The TULIPA registry was funded by GlaxoSmithKline GmbH und Co KG, Munich.
Keywords
Deep-vein thrombosis - guidelines - clinical decision rules - ultrasonography - health
care research