M Z Papa1, I Rabi, R Adar. 1. Department of General and Vascular Surgery, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Abstract
INTRODUCTION: The literature on thromboangiitis obliterans (TAO, Buerger's disease) suffers from the lack of a unified method of establishing the diagnosis of the disease. The aim of this study was to test the application of a point scoring system (PSS) in the diagnosis of TAO. METHOD: Points are awarded for young age at onset, foot claudication, upper extremity involvement, superficial vein thrombosis and vasospastic phenomena. Atypical features detract points, and the resultant score classifies the diagnosis of TAO as being of low, medium or high probability. One hundred and seven patients diagnosed and classified according to our previous accepted criteria for TAO, were independently reclassified by the PSS, and the results of the two diagnostic processes were compared. RESULTS: Of the 107 patients diagnosed by our old criteria (OC) the diagnosis of TAO was rejected by the PSS in 20 patients. Of the remaining 87 patients the degree of certainty in the diagnosis (PSS vs. OC) was lower in 31 equal in 47 and higher only in nine. CONCLUSION: The proposed PSS is more discriminating than our OC. If this type of scoring system can be agreed upon the certainty in the diagnosis of TAO would be increased. Data collection would be improved, and the cause of clinical and basic research would be advanced.
INTRODUCTION: The literature on thromboangiitis obliterans (TAO, Buerger's disease) suffers from the lack of a unified method of establishing the diagnosis of the disease. The aim of this study was to test the application of a point scoring system (PSS) in the diagnosis of TAO. METHOD: Points are awarded for young age at onset, foot claudication, upper extremity involvement, superficial vein thrombosis and vasospastic phenomena. Atypical features detract points, and the resultant score classifies the diagnosis of TAO as being of low, medium or high probability. One hundred and seven patients diagnosed and classified according to our previous accepted criteria for TAO, were independently reclassified by the PSS, and the results of the two diagnostic processes were compared. RESULTS: Of the 107 patients diagnosed by our old criteria (OC) the diagnosis of TAO was rejected by the PSS in 20 patients. Of the remaining 87 patients the degree of certainty in the diagnosis (PSS vs. OC) was lower in 31 equal in 47 and higher only in nine. CONCLUSION: The proposed PSS is more discriminating than our OC. If this type of scoring system can be agreed upon the certainty in the diagnosis of TAO would be increased. Data collection would be improved, and the cause of clinical and basic research would be advanced.