Diagnostic Utility of Clinical Scoring System and D-Dimer Assay in Suspected Cerebral Venous Thrombosis: A Prospective Observational Study.

OBJECTIVE: This study aimed to evaluate the diagnostic accuracy of a clinical scoring system, both alone and in combination with D-dimer assay, for suspected cerebral venous thrombosis (CVT) in the emergency department. METHODS: This prospective observational study was conducted in the Emergency Department of a tertiary care teaching hospital in India. Patients who met the inclusion criteria were assessed using a CVT scoring system. They underwent non-contrast computed tomogography of the brain to rule out other types of strokes and to detect signs of CVT. D-dimer testing was also performed. The diagnosis of CVT was subsequently confirmed by magnetic resonance venography (MRV). RESULTS: Among the75 study subjects, the frequency of CVT, as confirmed by MRV, was 53.33%. Elevated D-dimer levels were observed in 32 out of 75 patients, of whom 26 (65%) patients had CVT. A low-probability clinical score demonstrated a sensitivity of 73.33% and a pecificity of 71.1% for ruling out CVT. When a low-probability score was combined with D-dimer values below 500 μg/L, the sensitivity for ruling out CVT improved to 92.5%. CONCLUSION: The present study indicated that moderate- and high-probability clinical scores were associated with a higher likelihood of CVT. In this cohort, a low-probability clinical score combined with a negative D-dimer assay had a high negative predictive value for CVT. While a moderate or high-probability score warranted urgent imaging, it could not confirm the diagnosis on its own. This approach is particularly useful in resource-limited settings for triaging and referring patients for the early initiation of treatment.