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A Practical Guide to Haemostasis


Upper Extremity Deep Vein Thrombosis [UEDVT]:
The Constans Clinical Decision Score

Introduction

The Constans Clinical Decision Score uses 4 variables to risk stratify patients with a suspected UEDVT.  The score was designed by a multivariate logistic regression analysis of
a sample of patients hospitalized for suspicion of UEDVT and then subsequently validated in subsequent studies.


The Constans Clinical Decision Score:


Select Criteria:

Patient Characteristics Score
Venous Material Present
[Central venous catheter or Pacemaker thread]
Yes 1 Point
No 0 Point
Localised Pain
Yes 1 Point
No 0 Points
Unilateral Oedema
Yes 1 Point
No 0 Points
Other Diagnosis at least as plausible
Yes -1 Points
No 0 Points

Score

[Max Score 3 Points]

Interpretation
Score UEDVT Probability1
 -1 or 0 Points  Low
  12% probability of UEDVT
 1 Point Intermediate
  20% probability of UEDVT
 2 - 3 Points High
  70% probability of UEDVT

1Data based on the derivation study.


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Modifications of The Constans Clinical Decision Score


In a modification of the Constans Clinical Decision Score, D-dimer was used to stratify those individuals with a low probability of UEDVT - see Kleinjan et al Ref 3. Individuals in whom from the Constans Clinical Decision Score, an UEDVT was unlikely [Score 1 or less] were further investigated by a D-dimer assay. Individuals with a score of 2 or 3 were classified at UEDVT likely and progressed to imaging.

In individuals in whom an UEDVT was unlikely if the D-dimer testing was normal then no further investigations were undertaken. In contrast if the D-dimer was raised, then imaging was performed.

The study demonstrated that a combination of a clinical decision score, D-dimer testing and ultrasonography could safely and effectively exclude an UEDVT.