Diagnostic Algorithm for Suspected Upper-Extremity Deep Venous Thrombosis

The rate of upper-extremity deep venous thrombosis (DVT) has risen in conjunction with more frequent use of central venous catheters. We have clear algorithms for diagnosing lower-extremity, but not upper-extremity, DVT. In this multicenter study, a diagnostic algorithm was assessed in 406 patients with suspected upper-extremity DVTs. Evaluation included calculating a clinical decision score, d-dimer testing, and ultrasonography. The clinical score consisted of +1 point each for presence of a central venous catheter or lead, localized pain, or unilateral edema and −1 point for a plausible alternate diagnosis. Scores of ≤1 implied that upper-extremity DVT was unlikely. Follow-up was 3 months. Upper-extremity DVTs were verified in 103 patient…