. 2012 Jan 23;141(2 Suppl):e351S–e418S. doi: 10.1378/chest.11-2299

Table 8.

—[Sections 4.1-4.3] Summary of Findings for Diagnostic Studies in Patients with Suspected Recurrent Lower Extremity DVT: Prospective Management Cohort Studies

Diagnostic Strategy Used to Exclude Recurrent DVT	No. of Participants (Studies)	Outcome	Incidence of VTE During Follow-up Among Patients Judged to Have Recurrent DVT Excluded (ie, Post-TP of DVT), % (95% CI)%	Quality of Evidence
Negative serial proximal CUS^162-165	Normal serial US			Moderate^a
	Day of presentation, day 2 [± 1], day 7 [± 1]: 150 (1)¹⁶³	VTE diagnosed during 6 mo of follow-up¹⁶³	1.3 (95 CI, 0.02-4.7)¹⁶³
	Day of presentation, day 1-3 and 6-10 (in patients with a positive DD): 129 (2)¹⁶⁵	VTE diagnosed during 3 mo of follow-up¹⁶⁵	2.3 (95 CI, 0.8-6.6)¹⁶⁵
	Normal or unchanged/improved residual venous diameter serial US			Low^b
	Day of presentation, day 2 [± 1], day 7 [± 1]: 86 (1)¹⁶²	VTE diagnosed during 6 mo of follow-up¹⁶²	3.1 (95 CI, 0.4-10.7)¹⁶²	Low^b
	Unchanged residual venous diameter ( < 4 mm)	VTE diagnosed during 3 mo of follow-up¹⁶⁴	4.8 (95 CI, 1.3-15.8)¹⁶⁴	Low^c
	Day of presentation and day 7: 42 (1)¹⁶⁴	VTE diagnosed during 3 mo of follow-up¹⁶⁴	4.8 (95 CI, 1.3-15.8)¹⁶⁴	Low^c
Unchanged residual venous diameter ( < 4 mm increase) on proximal CUS and a negative highly sensitive DD (Biopool AutoDimer)¹⁶⁶	75 (1)	VTE diagnosed during 3 mo of follow-up	0 (95 CI, 0-4.8)	Moderate^d
Unlikely pre-TP and negative highly sensitive DD (STA Liatest)¹⁶⁷	16 (1)	VTE diagnosed during 3 mo of follow-up	0 (95 CI, 9-19.4)	Low^e
Negative highly sensitive DD	STA Liatest DD: 134 (1)¹⁶⁸	VTE diagnosed during 3 mo of follow-up	0.75 (95 CI, 0.02-4.1)	Moderate^f
Negative highly sensitive DD	MDA DD: 229 (1)¹⁶⁵		1.71 (95 CI, 0.7-4.4)	Moderate^f

Consequences in terms of presenting with VTE during clinical follow-up when specific strategies are used to rule out suspected recurrent DVT. GRADE Working Group grades of evidence: High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. See Table 1 and 3 legends for expansion of abbreviations.

Bates et al¹⁶⁵ published only in abstract.

Single study; point estimate for post-TP of DVT > 2%; very serious imprecision, wide 95% CI.

Single study; unclear if consecutive or selected patients used; point estimate for post-TP of DVT > 2%; wide 95% CI.

Single-center study; wide 95% CI.

Only 15% of patients presenting to the ED with suspected DVT could be managed with this strategy, single study, very wide 95% CI.

No data on patients with various pre-TPs; unable to determine exact overall prevalence of recurrent DVT¹⁶⁸; published in abstract only¹⁶⁵; for both studies, wide 95% CI.