IEEE Systems, Man and Cybernetics Magazine - April 2023 - 51

abstracts, 72 relevant articles were
selected. In these articles, we ex -
cluded some articles that use
si milar methods. We eventually
selected 41 informative and prospective
articles. This article
reviews the benefits and limitations
of US and D-dimer used in
the diagnostic management of traditional
DVT. The advantages of
POCUS, POC D-dimer, and PPG for
early diagnosis and application in a
nonmedical context are illustrated
by an analysis of current clinical diagnostic needs for DVT,
and they are analyzed according to their features, such as
the sensitivity, specificity, and precision of the preceding
methods. Finally, the future of POCT equipment in the
diagnosis of DVT is discussed.
In 1989, the study conducted by
D-dimer cannot be
used as a single
marker for diagnosing
DVT, but it is a
powerful tool for
positive screening.
Bounameaux was the first to
show the positive role of D-dimer
in the positive diagnosis of DVT
[10]. Relative to venography, the
sensitivity with D-dimer was
100%, but the false positive rate
was 69%. Therefore, D-dimer is
more suitable for positive screening.
Meanwhile, another study by
Bounameaux on acute patients
showed a sensitivity range of 60%-
76% and a specificity range of
Clinical Diagnosis
Venography is widely used to determine the location and
morphology of a thrombus before DVT surgery. However,
conventional diagnostic management frequently uses a
combination protocol of D-dimer and US, as shown in Figure
1. The management can be effective in screening DVT
patients. US is carried out directly for patients with typical
signs and suggestive symptoms of DVT. Positive testing
with D-dimer is used when the likelihood assessment is
high without significant precipitating factors and typical
presenting signs. If the screening is positive, US is used for
other diagnostics; if the test is negative, the risk of DVT is
eliminated. Methods such as venography should still be
considered when US cannot be used in diagnosing some
patients [14], [15].
D-Dimer
D-dimer is a degradation product of
cross-linked fibrin, and its increase indicates
fibrinolysis. When thrombosis is
generated, it is associated with fibrinolytic
events. As a result, the rise of
D-dimer marks a thromboembol ic
occurrence [16]. However, fibrin breakdown
events also occur frequently under
nonthromboembolic conditions, such as
acute inflammation. Therefore, a high
D-dimer level is insufficient to determine
the occurrence of a thrombus,
which will lead to a high incidence of
false positives. Consequently, D-dimer
cannot be used as a single marker for
diagnosing DVT, but it is a powerful tool
for positive screening. Table 1 summarizes
the sensitivity and specificity values
for D-dimer when it is used on its own
and in combination with biomarkers.
87%-97%. The result suggests that D-dimer has large fluctuations
in the results of low-level fibrin testing and is
unsuitable for screening DVT in acutely ill patients. In
2000, Borne et al. compared 10 different D-dimer assays.
They suggested that two D-dimer methods had 100% sensitivity
and 40% specificity. It shows that D-dimer has a
strong positive screening ability for DVT [17]. A study in
2020 concluded that COVID-19 had the risk of potentially
causing DVT. By performing D-dimer screening, the
results showed a sensitivity of 95.7% and a specificity of
29.3%, which could effectively screen COVID-19 patients
with early DVT [18]. In the same year, a review study by
Rinde et al., after analysis of 1,765 suspected DVT
patients from Norway from 2008 to 2018, revealed that
the majority of misdiagnosed patients treated by diagnosis
using D-dimer were distal DVT patients, while the failure
rate of diagnosis in proximal DVT patients was 0.6%.
It suggests that D-dimer can be used as a stand-alone test
to screen for proximal DVT. It would reduce the number
of US examinations [19].
Table 1. Selected studies using D-dimer in the
diagnosis of DVT.
Reference
method
Venography
US
Number
of subjects
(control/patient) Sensitivity (%) Specificity (%)
56 (32/24)
99 (49/50)
156 (133/23)
1,765 (1,472/293)
60-76
80-83
95.7
96.6-98.3
87-97
87-94
29.3
21.5-43.1
Table 2. Selected studies using US in the
diagnosis of DVT.
Diagnosis
method
Reference
method
B-mode US Venography
Number
of subjects
Duplex US
(control/patient)
145 (45/100)
23 (12/11)
50 (25/25)
51 (23/28)
Sensitivity
(%)
94
100
88
89
Specificity
(%)
100
92
96
100
Study
Dauzat 1986 [21]
Sullivan 1984 [22]
Daniel 1988 [23]
Cronan 1987 [24]
April 2023 IEEE SYSTEMS, MAN, & CYBERNETICS MAGAZINE 51
Study
Bounameau 1989 [10]
Vandenborne 2000 [17]
Demelo 2020 [18]
Rinde 2020 [19]
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