SÍNDROME POSTROMBÓTICO: VALIDACIÓN DE UNA ESCALA TELEFÓNICA COMO HERRAMIENTA DIAGNÓSTICA*

resumen Introduccion El SPT es una condicion clinica que afecta hasta el 50% de los pacientes luego de una TVP. Su ocurrencia es independiente de la anticoagulacion adecuada y genera un alto costo asistencial. La escala de Villalta es una herramienta de uso clinico validada para el diagnosticoy seguimiento del SPT. Objetivo Evaluar la validez de la administracion telefonica de la escala de Villalta para el diagnostico de SPT. Materiales y metodo Corte transversal de Agosto 2009 a Marzo 2010 de pacientes > 17 anos con TVP de miembros inferiores incluidos en el Registro Institucional de Enfermedad Tromboembolica (RIET) en el Hospital Italiano de Buenos Aires. Fueron evaluados telefonicamente 236 pacientes en busqueda del SPT utilizando una adaptacion del cuestionario de Villalta. A posteriori, estos pacientes fueron evaluados independientemente en forma ciega por dos medicos internistas utilizando la escala clinica de Villalta. Resultados El 19 % tuvo diagnostico telefonico de SPT, 59 % (138) eran de sexo femenino con una mediana de edad 72 anos (RI 20). Los kappa de acuerdo entre la adaptacion telefonica y el score de Villalta fueron estadisticamente significativo para los items: pesadez, dolor, prurito,  calambre y edema. La correlacion entre ambos scores es 0,52 (coeficiente de Spearman, p = 0,007). La consistencia interna de Villalta validada (n = 32) fue alpha = 0,82 y para Villalta telefonico (n = 170) alpha = 0,75. Conclusiones La adaptacion del score de Villalta seria potencialmente una herramienta clinica valida para el diagnostico del SPT. Es necesario un tamano muestral mayor para probar la validez de la escala telefonica. palabras clave Enfermedad tromboembolica venosa, sindrome trombotico post, la trombosis venosa profunda. POSTROMBOTIC SYNDROME: VALIDATION OF A TELEPHONE SCORE AS DIAGNOSTIC TOOL abstract Introduction Post-thrombotic syndrome (PTS) is a chronic condition affecting up to 50% of patients after a TVP event. Its incidence is independent of adequate anticoagulation, and poses a high cost burden on the medical system. The Villalta scale is a validated clinical tool to diagnose and follow-up patients with SPT. Objective To assess the validity of an adapted telephonic tool for the diagnosis of PTS. Methods Cross-sectional study of patients >17 years with a diagnosis of lower extremity DVT, included in the Institutional Registry of thromboembolic disease (IRTD) of the Italian Hospital of Buenos Aires, from August 2009 to March 2010. Patients were assessed by telephone for the presence of PTS with an adaptation of the Villalta questionnaire. These patients were evaluated independently by 2 certified internists with the Villalta questionnaire. Results Of 236 patients with DVT, 19% were diagnosed with PTS with the adapted telephonic questionnarie. Fifty nine percent (138) were females and the median age was 72 years. Agreement between the telephonic adaption and Villalta questionnaire was,significant for the items heaviness, pain, itching, cramping and edema. Correlation between both questionnaires was 0.52 (Spearman coefficient, p= 0.007). Cronbach alpha for internal consistency was 0.82 (n = 32) for the Villalta scale and 0.75 (n = 170) for the telephonic adaptation. Discussion The telephonic adaptation of the Villalta scale is potentially a valid clinical tool for the diagnosis of PTS. Further studies to address the full validity of the telephonic questionnaire will need to be done with more patients. key words : Venous thromboembolism, post thrombotic syndrome, deep vein thrombosis.