Passman MA, McLafferty RB, Lentz MF, Nagre SB, Iafrati MD, Bohannon WT, Moore CM, Heller JA, Schneider JR, Lohr JM, Caprini JA, et al.
Journal of vascular surgery. Date of publication 2011 Dec 1;volume 54(6 Suppl):2S-9S.
1. J Vasc Surg. 2011 Dec;54(6 Suppl):2S-9S. doi: 10.1016/j.jvs.2011.05.117. Epub
2011 Oct 1.
Validation of Venous Clinical Severity Score (VCSS) with other venous severity
assessment tools from the American Venous Forum, National Venous Screening
Program.
Passman MA(1), McLafferty RB, Lentz MF, Nagre SB, Iafrati MD, Bohannon WT, Moore
CM, Heller JA, Schneider JR, Lohr JM, Caprini JA.
Author information:
(1)Section of Vascular Surgery and Endovascular Therapy, University of Alabama
at Birmingham, Birmingham, AL 35294-0012, USA. marc.passman@ccc.uab.edu
BACKGROUND: Several standard venous assessment tools have been used as
independent determinants of venous disease severity, but correlation between
these instruments as a global venous screening tool has not been tested. The
scope of this study is to assess the validity of Venous Clinical Severity
Scoring (VCSS) and its integration with other venous assessment tools as a
global venous screening instrument.
METHODS: The American Venous Forum (AVF), National Venous Screening Program
(NVSP) data registry from 2007 to 2009 was queried for participants with
complete datasets, including CEAP clinical staging, VCSS, modified Chronic
Venous Insufficiency Quality of Life (CIVIQ) assessment, and venous ultrasound
results. Statistical correlation trends were analyzed using Spearman's rank
coefficient as related to VCSS.
RESULTS: Five thousand eight hundred fourteen limbs in 2,907 participants were
screened and included CEAP clinical stage C0: 26%; C1: 33%; C2: 24%; C3: 9%; C4:
7%; C5: 0.5%; C6: 0.2% (mean, 1.41 ± 1.22). VCSS mean score distribution (range,
0-3) for the entire cohort included: pain 1.01 ± 0.80, varicose veins 0.61 ±
0.84, edema 0.61 ± 0.81, pigmentation 0.15 ± 0.47, inflammation 0.07 ± 0.33,
induration 0.04 ± 0.27, ulcer number 0.004 ± 0.081, ulcer size 0.007 ± 0.112,
ulcer duration 0.007 ± 0.134, and compression 0.30 ± 0.81. Overall correlation
between CEAP and VCSS was moderately strong (r(s) = 0.49; P < .0001), with
highest correlation for attributes reflecting more advanced disease, including
varicose vein (r(s) = 0.51; P < .0001), pigmentation (r(s) = 0.39; P < .0001),
inflammation (r(s) = 0.28; P < .0001), induration (r(s) = 0.22; P < .0001), and
edema (r(s) = 0.21; P < .0001). Based on the modified CIVIQ assessment, overall
mean score for each general category included: Quality of Life (QoL)-Pain 6.04 ±
3.12 (range, 3-15), QoL-Functional 9.90 ± 5.32 (range, 5-25), and QoL-Social
5.41 ± 3.09 (range, 3-15). Overall correlation between CIVIQ and VCSS was
moderately strong (r(s) = 0.43; P < .0001), with the highest correlation noted
for pain (r(s) = 0.55; P < .0001) and edema (r(s) = 0.30; P < .0001). Based on
screening venous ultrasound results, 38.1% of limbs had reflux and 1.5%
obstruction in the femoral, saphenous, or popliteal vein segments. Correlation
between overall venous ultrasound findings (reflux + obstruction) and VCSS was
slightly positive (r(s) = 0.23; P < .0001) but was highest for varicose vein
(r(s) = 0.32; P < .0001) and showed no correlation to swelling (r(s) = 0.06; P <
.0001) and pain (r(s) = 0.003; P = .7947).
CONCLUSIONS: While there is correlation between VCSS, CEAP, modified CIVIQ, and
venous ultrasound findings, subgroup analysis indicates that this correlation is
driven by different components of VCSS compared with the other venous assessment
tools. This observation may reflect that VCSS has more global application in
determining overall severity of venous disease, while at the same time
highlighting the strengths of the other venous assessment tools.
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All
rights reserved.
DOI: 10.1016/j.jvs.2011.05.117
PMID: 21962926 [Indexed for MEDLINE]
