Tracking the Uptake of Evidence

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Abstract
ADVANCES IN clinical trial methods have led to a progression of clinical trials evaluating diagnostic1 and treatment modalities2,3 that have profoundly affected the clinical management of patients with venous thromboembolism. Large volumes of evidence have been generated during the past 2 decades by researchers in the clinical field of venous thromboembolism. In particular, rigorous prospective studies (level 1)1,4-7 have confirmed or refuted dogmatic approaches to the diagnosis of venous thromboembolism by evaluating a broad spectrum of randomized consecutive patients, using a definitive reference test, and interpreting the results of each test or outcome without knowledge of the other test findings. The result has been a paradigm shift in the literature toward more rigorous approaches to the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE). Outcome studies, with long-term follow-up to determine the safety of withholding treatment in patients with negative results, have allowed refinement of the diagnostic pathway.1,8

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