Relationship of the Novel Scoring System for Lower Extremity Venous Thrombosis with Pulmonary Embolism

Rationale and Objective

To develop a new scoring system, the "Lower extremity venous Doppler ultrasound scoring system" (LEVDUS), to predict the diagnosis of pulmonary embolism (PE) localization in patients with deep vein thrombosis (DVT).

Methods

This single-center retrospective study included 182 patients aged ≥ 18 years. We used scoring according to thrombosis localization and stage in Doppler US. Patients with PE were divided into three categories based on the pulmonary artery (PA) location on CT pulmonary angiography. LEVDUS values were compared according to the PE classification. The threshold value was determined for the diagnosis of PE in the receiver operating characteristics analysis. Factors affecting the diagnosis of PE were evaluated by logistic regression analysis.

Results

A total of 182 patients were included (female patients: 55.5% [101/182]). The median age of the patients was 68 (IQR, 56–77). The rates of DVT and PE were 35.2% (64/182) and 52.7% (96/182), respectively. Although the median LEVDUS and d-dimer values in the subsegmental PE group were higher, LEVDUS was statistically significant but d-dimer was not (p = 0.005 and p = 0.022, respectively). In addition, both LEVDUS and d-dimer median values in the other PE groups were statistically significantly higher than the non-PE group (p < 0.001). The cut-off value for the diagnosis of PE was LEVDUS≥ 2.5. LEVDUS was 1.2-fold higher for the presence of PE.

Conclusion

LEVDUS provides useful information in predicting the presence of PE in patients and provides a common diagnostic language between radiologists and emergency or clinic physicians.