Ascribing leg symptoms to chronic venous disorders: The construction of a diagnostic score

Objectives The goal was to create a simple diagnostic scoring system able to differentiate leg symptoms related to chronic venous disorders (CVD) from those produced by other causes. Methods A prospective observational study was done of ambulatory or hospitalized patients from 13 private and five in...

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Veröffentlicht in:Journal of vascular surgery 2007-11, Vol.46 (5), p.991-996
Hauptverfasser: Carpentier, Patrick H., MD, Poulain, Caroline, MD, Fabry, Régine, PhD, Chleir, Franck, MD, Guias, Bruno, MD, Bettarel-Binon, Catherine, MD
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container_end_page 996
container_issue 5
container_start_page 991
container_title Journal of vascular surgery
container_volume 46
creator Carpentier, Patrick H., MD
Poulain, Caroline, MD
Fabry, Régine, PhD
Chleir, Franck, MD
Guias, Bruno, MD
Bettarel-Binon, Catherine, MD
description Objectives The goal was to create a simple diagnostic scoring system able to differentiate leg symptoms related to chronic venous disorders (CVD) from those produced by other causes. Methods A prospective observational study was done of ambulatory or hospitalized patients from 13 private and five institutional vascular centers. Two groups of patients with leg symptoms were investigated. The CVD-positive (CVD+) patients had clinically documented CVD and significant venous reflux at duplex ultrasound examination, but no arterial, rheumatologic, or neurologic disorders. The CVD-negative (CVD−) patients had disorders of an arterial, rheumatic, or neurologic origin but no clinical or duplex ultrasound signs of CVD. Patients completed a 54-item questionnaire characterizing their symptoms. Items of the diagnostic score were selected as those associated with the highest likelihood ratio (LR) for CVD in a first series of patients. They were combined into a few criteria, the number of which, when validated in a patient, would produce the value of the score for this patient. Selection of the most relevant score was performed through the comparison of the surface area under receiver operating characteristic curves. The construct validity of this score was evaluated through a factor analysis. The diagnostic performance of the scoring system was evaluated in a second series of patients similar to the first series. Results In the construction phase, 123 CVD+ patients and 94 CVD− patients were enrolled. The validation series consisted of 92 patients (67 venous and 25 nonvenous). The most efficient scoring system was composed of four combined criteria: sensation of heavy or swollen legs (sensitivity, 0.82; specificity, 0.55; LR, 1.84); associated with itching, impatient legs, or phlebalgia (sensitivity, 0.55; specificity, 0.92; LR, 6.41); worsened by a hot environment or improved by a cold environment (sensitivity, 0.78; specificity, 0.71; LR, 2.72); not worsened by walking (sensitivity, 0.89; specificity, 0.62; LR, 2.33). The score was calculated as the number (0 to 4) of the above criteria validated by the patient, with a threshold level of >3, it was shown to have a high specificity (0.95) and a fair sensitivity (0.75) for CVD. Factor analysis showed the construct validity of the score, and consistent results were found in the validation series. Conclusion The clinical relevance of this scoring system remains to be evaluated prospectively in standard clinical conditions
doi_str_mv 10.1016/j.jvs.2007.06.044
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Methods A prospective observational study was done of ambulatory or hospitalized patients from 13 private and five institutional vascular centers. Two groups of patients with leg symptoms were investigated. The CVD-positive (CVD+) patients had clinically documented CVD and significant venous reflux at duplex ultrasound examination, but no arterial, rheumatologic, or neurologic disorders. The CVD-negative (CVD−) patients had disorders of an arterial, rheumatic, or neurologic origin but no clinical or duplex ultrasound signs of CVD. Patients completed a 54-item questionnaire characterizing their symptoms. Items of the diagnostic score were selected as those associated with the highest likelihood ratio (LR) for CVD in a first series of patients. They were combined into a few criteria, the number of which, when validated in a patient, would produce the value of the score for this patient. Selection of the most relevant score was performed through the comparison of the surface area under receiver operating characteristic curves. The construct validity of this score was evaluated through a factor analysis. The diagnostic performance of the scoring system was evaluated in a second series of patients similar to the first series. Results In the construction phase, 123 CVD+ patients and 94 CVD− patients were enrolled. The validation series consisted of 92 patients (67 venous and 25 nonvenous). The most efficient scoring system was composed of four combined criteria: sensation of heavy or swollen legs (sensitivity, 0.82; specificity, 0.55; LR, 1.84); associated with itching, impatient legs, or phlebalgia (sensitivity, 0.55; specificity, 0.92; LR, 6.41); worsened by a hot environment or improved by a cold environment (sensitivity, 0.78; specificity, 0.71; LR, 2.72); not worsened by walking (sensitivity, 0.89; specificity, 0.62; LR, 2.33). The score was calculated as the number (0 to 4) of the above criteria validated by the patient, with a threshold level of &gt;3, it was shown to have a high specificity (0.95) and a fair sensitivity (0.75) for CVD. Factor analysis showed the construct validity of the score, and consistent results were found in the validation series. Conclusion The clinical relevance of this scoring system remains to be evaluated prospectively in standard clinical conditions. However, these results already document that venous symptoms can be differentiated from leg symptoms of other origins.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2007.06.044</identifier><identifier>PMID: 17980285</identifier><identifier>CODEN: JVSUES</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Cardiovascular system ; Chronic Disease ; Factor Analysis, Statistical ; Female ; Health Status Indicators ; Humans ; Likelihood Functions ; Male ; Medical sciences ; Middle Aged ; Pharmacology. Drug treatments ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Ultrasonography, Doppler, Duplex ; Vascular Diseases - diagnosis ; Vascular surgery: aorta, extremities, vena cava. 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Methods A prospective observational study was done of ambulatory or hospitalized patients from 13 private and five institutional vascular centers. Two groups of patients with leg symptoms were investigated. The CVD-positive (CVD+) patients had clinically documented CVD and significant venous reflux at duplex ultrasound examination, but no arterial, rheumatologic, or neurologic disorders. The CVD-negative (CVD−) patients had disorders of an arterial, rheumatic, or neurologic origin but no clinical or duplex ultrasound signs of CVD. Patients completed a 54-item questionnaire characterizing their symptoms. Items of the diagnostic score were selected as those associated with the highest likelihood ratio (LR) for CVD in a first series of patients. They were combined into a few criteria, the number of which, when validated in a patient, would produce the value of the score for this patient. Selection of the most relevant score was performed through the comparison of the surface area under receiver operating characteristic curves. The construct validity of this score was evaluated through a factor analysis. The diagnostic performance of the scoring system was evaluated in a second series of patients similar to the first series. Results In the construction phase, 123 CVD+ patients and 94 CVD− patients were enrolled. The validation series consisted of 92 patients (67 venous and 25 nonvenous). The most efficient scoring system was composed of four combined criteria: sensation of heavy or swollen legs (sensitivity, 0.82; specificity, 0.55; LR, 1.84); associated with itching, impatient legs, or phlebalgia (sensitivity, 0.55; specificity, 0.92; LR, 6.41); worsened by a hot environment or improved by a cold environment (sensitivity, 0.78; specificity, 0.71; LR, 2.72); not worsened by walking (sensitivity, 0.89; specificity, 0.62; LR, 2.33). The score was calculated as the number (0 to 4) of the above criteria validated by the patient, with a threshold level of &gt;3, it was shown to have a high specificity (0.95) and a fair sensitivity (0.75) for CVD. Factor analysis showed the construct validity of the score, and consistent results were found in the validation series. Conclusion The clinical relevance of this scoring system remains to be evaluated prospectively in standard clinical conditions. However, these results already document that venous symptoms can be differentiated from leg symptoms of other origins.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiovascular system</subject><subject>Chronic Disease</subject><subject>Factor Analysis, Statistical</subject><subject>Female</subject><subject>Health Status Indicators</subject><subject>Humans</subject><subject>Likelihood Functions</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pharmacology. Drug treatments</subject><subject>Prospective Studies</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Ultrasonography, Doppler, Duplex</subject><subject>Vascular Diseases - diagnosis</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><subject>Vascular wall</subject><subject>Venous Insufficiency - diagnosis</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUGL1DAYhoMo7rj6A7xIL3pr_ZJ2kkZhYVlcFRY8uF68hDT5OpvaacZ87cD8ezPMsIIHT7k878uX52XsNYeKA5fvh2rYUyUAVAWygqZ5wlYctCplC_opW4FqeLkWvLlgL4gGAM7XrXrOLrjSLYh2vWI_r8ml0IVpU4y4Keiw3c1xS8UcC_eQ4hRcsccpLlT4QDF5TPShuH_AwsWJ5rS4OcSpiH1hM2A3U6Q5R8jFhC_Zs96OhK_O7yX7cfvp_uZLefft89eb67vSNUrPJefadaC1kyjqXjd1JxrPFWreyFYCCKh929YanPbrjvdC9j3qzloPXqoW60v27tS7S_H3gjSbbSCH42gnzIcb2TaqhlpkkJ9AlyJRwt7sUtjadDAczFGoGUwWao5CDUiThebMm3P50m3R_02cDWbg7Rmw5OzYJzu5QI9c7sqf0DxzH08cZhX7gMmQCzg59CGhm42P4b9nXP2TdmPI49jxFx6QhrikKTs23JAwYL4flz8ODypvLoSs_wC9kqhz</recordid><startdate>20071101</startdate><enddate>20071101</enddate><creator>Carpentier, Patrick H., MD</creator><creator>Poulain, Caroline, MD</creator><creator>Fabry, Régine, PhD</creator><creator>Chleir, Franck, MD</creator><creator>Guias, Bruno, MD</creator><creator>Bettarel-Binon, Catherine, MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20071101</creationdate><title>Ascribing leg symptoms to chronic venous disorders: The construction of a diagnostic score</title><author>Carpentier, Patrick H., MD ; Poulain, Caroline, MD ; Fabry, Régine, PhD ; Chleir, Franck, MD ; Guias, Bruno, MD ; Bettarel-Binon, Catherine, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c479t-119cb099c6e23f943b24d17e91468600203d88390c9d5b1f26ffe9baad0d678e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiovascular system</topic><topic>Chronic Disease</topic><topic>Factor Analysis, Statistical</topic><topic>Female</topic><topic>Health Status Indicators</topic><topic>Humans</topic><topic>Likelihood Functions</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pharmacology. Drug treatments</topic><topic>Prospective Studies</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Ultrasonography, Doppler, Duplex</topic><topic>Vascular Diseases - diagnosis</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><topic>Vascular wall</topic><topic>Venous Insufficiency - diagnosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Carpentier, Patrick H., MD</creatorcontrib><creatorcontrib>Poulain, Caroline, MD</creatorcontrib><creatorcontrib>Fabry, Régine, PhD</creatorcontrib><creatorcontrib>Chleir, Franck, MD</creatorcontrib><creatorcontrib>Guias, Bruno, MD</creatorcontrib><creatorcontrib>Bettarel-Binon, Catherine, MD</creatorcontrib><creatorcontrib>Venous Working Group of the Société Française de Médecine Vasculaire</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Carpentier, Patrick H., MD</au><au>Poulain, Caroline, MD</au><au>Fabry, Régine, PhD</au><au>Chleir, Franck, MD</au><au>Guias, Bruno, MD</au><au>Bettarel-Binon, Catherine, MD</au><aucorp>Venous Working Group of the Société Française de Médecine Vasculaire</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ascribing leg symptoms to chronic venous disorders: The construction of a diagnostic score</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2007-11-01</date><risdate>2007</risdate><volume>46</volume><issue>5</issue><spage>991</spage><epage>996</epage><pages>991-996</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><coden>JVSUES</coden><abstract>Objectives The goal was to create a simple diagnostic scoring system able to differentiate leg symptoms related to chronic venous disorders (CVD) from those produced by other causes. Methods A prospective observational study was done of ambulatory or hospitalized patients from 13 private and five institutional vascular centers. Two groups of patients with leg symptoms were investigated. The CVD-positive (CVD+) patients had clinically documented CVD and significant venous reflux at duplex ultrasound examination, but no arterial, rheumatologic, or neurologic disorders. The CVD-negative (CVD−) patients had disorders of an arterial, rheumatic, or neurologic origin but no clinical or duplex ultrasound signs of CVD. Patients completed a 54-item questionnaire characterizing their symptoms. Items of the diagnostic score were selected as those associated with the highest likelihood ratio (LR) for CVD in a first series of patients. They were combined into a few criteria, the number of which, when validated in a patient, would produce the value of the score for this patient. Selection of the most relevant score was performed through the comparison of the surface area under receiver operating characteristic curves. The construct validity of this score was evaluated through a factor analysis. The diagnostic performance of the scoring system was evaluated in a second series of patients similar to the first series. Results In the construction phase, 123 CVD+ patients and 94 CVD− patients were enrolled. The validation series consisted of 92 patients (67 venous and 25 nonvenous). The most efficient scoring system was composed of four combined criteria: sensation of heavy or swollen legs (sensitivity, 0.82; specificity, 0.55; LR, 1.84); associated with itching, impatient legs, or phlebalgia (sensitivity, 0.55; specificity, 0.92; LR, 6.41); worsened by a hot environment or improved by a cold environment (sensitivity, 0.78; specificity, 0.71; LR, 2.72); not worsened by walking (sensitivity, 0.89; specificity, 0.62; LR, 2.33). The score was calculated as the number (0 to 4) of the above criteria validated by the patient, with a threshold level of &gt;3, it was shown to have a high specificity (0.95) and a fair sensitivity (0.75) for CVD. Factor analysis showed the construct validity of the score, and consistent results were found in the validation series. Conclusion The clinical relevance of this scoring system remains to be evaluated prospectively in standard clinical conditions. However, these results already document that venous symptoms can be differentiated from leg symptoms of other origins.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>17980285</pmid><doi>10.1016/j.jvs.2007.06.044</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record>
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subjects Adult
Aged
Biological and medical sciences
Cardiovascular system
Chronic Disease
Factor Analysis, Statistical
Female
Health Status Indicators
Humans
Likelihood Functions
Male
Medical sciences
Middle Aged
Pharmacology. Drug treatments
Prospective Studies
ROC Curve
Sensitivity and Specificity
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Ultrasonography, Doppler, Duplex
Vascular Diseases - diagnosis
Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
Vascular wall
Venous Insufficiency - diagnosis
title Ascribing leg symptoms to chronic venous disorders: The construction of a diagnostic score
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