Thepatients suffering from deep vein thrombosis develop a huge perilaspect for acquiring the venous thrombosis. The deep vein thrombosislacks a certain test upon which medical professionals can rely on tomake a full diagnosis. The reasons for that starts/ with that thesymptoms of the disease are not specific to qualify them in thediagnosis process (InDavies 2011).Additionally, the physical conclusions obtained from the individualspossess a limited predictive value (InDavies 2011).Consequently, the medical professionals came up with clinicalprediction rules that help with the full process of identification ofthe deep vein thrombosis. Using the various prediction rules, themedical professionals could manipulate the personal inputs of varyingcomponents covering the physical examination, laboratory results, andmedical history of the patient to try to come up with the fulldiagnosis of the disease and map out the possible treatmentprocedures. Therefore, the purpose of the review is to question andanalyze the present evidence about the diagnostic correctness of themedical forecast rules. More so, the review exploits the evidence ofthe level of success of the usage of the clinical calculation rulesin carrying out the analysis of the deep vein thrombosis andpulmonary embolus.
Theresults of the specific study proved twenty-three relevant systemicrevises and thirty-six primary studies. Out of the twenty-two,seventeen cases took a keen interest in the in the evaluation offorecast rules for the identification of the deep vein thrombosis(DVT). Those remaining five studied the rules dictating diagnosis ofthe pulmonary embolus. The review discovered that the latest rule todictate the DVT diagnosis was the Wells rule. The Well rule posted a6.62 median positive probability ratio for all the patients withelevated pretest likelihood, 1 for those with medium pretestlikelihood, and 0.22 for those with low pretest probability. More so,the review applied the ROC curve, to cover an area of 0.82. Uponadding the D-dimer test, the medium area covered by the covered shotto 0.90. More results showed the Wells rule had a huge usage in thediagnosis of the pulmonary embolus. In the condition, the regionunder the ROC curve was similar to the case of deep vein thrombosis.Conclusions of the review showed the Wells rule had a properapplication when determining the patients with a low risk of gettinga diagnosis for the venous thrombosis. Inputting the D-dimer raisedthe performance of the prediction rules (Bhandari 2012). The validityof the results is strong and lays to that the strength of theevidence changes across various applications. The eligibility of theresults can help in practicing advanced practice nursing or inregistered nursing since the rules have a huge input in establishingpretest likelihood for the presence of deep vein thrombosis or thepulmonary embolus. Tests that are more definitive should occur to thepatients (Bhandari 2012). The results from the predictive rules couldthen have an input in the interpretation of the definitive tests forthe diagnosis of the two conditions. The funding process waspartially from the Johns Hopkins Evidence-Based Practice Centerfollowing the directive of Contract to the Agency for HealthcareResearch and Quality (Ashar 2012).
Thestrength of the review process is the fact that the review exploredmultiple predictive rules in depth to come up with the apparentconclusions. More so, the researchers found out the Wells rule had ahigh and more accurate usage as compared to the rest of the rules(Griffin 2013). Additionally, the review used a binomial distributionin the calculation of the confidence distances regarding the varioussensitivities and specificities of the review. The ROC curves usedmaximum probability approximation processes, incorporating a binomialdistribution. The evidence used in the review faced scrutiny from twoauthors using the Strength of Recommendations Taxonomy. Most of thework did not have any two independent watchers using the predictiverules to learn the nature of the patients. The research failed toinclude the published results that study the test properties ofmulti-detector CT scans. Additionally, the review fails to includethe systemic reviews that showed the used of collective formulas forthe diagnosis of the DVT and the pulmonary embolus.
Theobjectives of the study had an accomplishment. Finding out that theWells rule was a successful rule in the diagnosis of the deep veinthrombosis and pulmonary embolus covered the initial goal of theresearch. The realization of the effectiveness of the Wells ruleunder the ROC curve further justifies the achievement of theobjectives of the study. More so, the review sets the Wells rule asan appropriate predictive tool to apply in the pretests of thediagnosis of the DVT and the pulmonary embolus. The review alsodiscovered that adding of the D-dimer improved on the overallaccuracy of the predictive rule. It met the objectives of determiningthe level of efficacy of the predictive rules in the diagnosis of thedeep vein thrombosis. More so, the addition of the D-dimer to therule helped identify the proximal deep vein thrombosis with a closeraccuracy than in identifying the distal deep vein thrombosis (InAaron 2015). However, establishing the reliability of the predictiverules in the full diagnosis of the two conditions fell short. Thereview states conclusively that the rules obtained cannot have a fullapplication to single out a case of pulmonary embolus or deep veinthrombosis. Instead, the predictive rules have a solid application aspretests and then the results used in the interpretation of theinformation acquired from other more definitive tests.
Ithink the findings of the review are imperative in the effortstowards a successful diagnosis of the two conditions. Despite theapparent limitations of the review, the rules from the review offer abetter chance for the medical professional to calculate the existentrisk while diagnosing deep vein thrombosis and pulmonary embolus.Using the various clinical predictive rules helps the nurses to applya standard formula to estimate the apparent risks in the diagnosis ofthe two diseases. More so, after the provision of the estimated risk,the physicians can then save up on the extra resources and directthem to other usages along the diagnosis path. The physicians canalso refrain from prescribing certain medication after the potentialrisks are established and the physicians pre-determine a treatmentplan. The allowance room for the nurses to have an estimate of thepossible danger relating to a disease would help them greatly to plotout a care giving path, one that includes countermeasures to rule outthe detrimental effects of the risks to the patients. The patientswith a low-risk factor for the deep vein thrombosis could eliminatethe need to go for further tests if the predictive rules point outthe low-risk poses no harm to the patient.
Ashar,B. (2012). Johnshopkins internal medicine board review: Certification andrecertification.Philadelphia: Elsevier Saunders.
Bhandari,M., & Adili, A. (2012). Evidence-basedorthopedics.Chichester, West Sussex, UK: Wiley-Blackwell.
Griffin,B. P., Callahan, T. D., Menon, V., Wu, W. M., Cauthen, C. A., &Dunn, J. M. (2013). Manualof cardiovascular medicine.Philadelphia: Wolters Kluwer Health/Lippincott Williams &Wilkins.
InAaron, R. K. (2015). Diagnosisand management of hip disease: Biological bases of clinical care.
InDavies, M. G., In Lumsden, A. B., & In Vykoukal, D. (2011).Venousthromboembolic disease.