Deep vein thrombosis: Homan's sign was not helpful in diagnosis.

Clinical bottom line (level 1b)

  1. In patients with suspected deep vein thrombosis, Homan's sign was unhelpful in diagnosing.
Sandler : Lancet 1985; 2 (8464): 1130-1131
Cranley et al: Archives of Surgery 1976; 111: 34-36
Expires June 2003

The study

Setting: tertiary medical centres, UK

184 patients (aged ?, ?% male)
  • (1) 80 in-patients with suspected deep vein thrombosis
  • (2) 104 patients referred by primary-care physician with suspected deep vein thrombosis


Independent blinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Reference standard:
  • venography
Diagnostic test: Homan's sign- positive if no dorsiflexion of the foot, on squeezing the calf muscle

The evidence

pre-test probability of DVT in 80 in-patients: 44%, (95% CI: 33% to 55%)
pre-test probability of DVT in referred patients: 57%, (95% CI: 47% to 66%)

diagnostic test DVT no DVT LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
Homan's sign 23 20 1.5
(0.99 to 2.2) 		53% 0.62
(0.36 to 1.05) 		32%
total 35 45


diagnostic test DVT no DVT LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
Homan's sign 28 18 1.2
(0.76 to 1.9) 		61% 0.88
(0.62 to 1.23) 		53%
total 59 45

Citation

  1. Sandler DR, : Homan's sign and medical education. Lancet 1985; 2 (8464): 1130-1131
  2. Cranley JJ, Canos AJ, Sull WJ: The diagnosis of deep venous thrombosis: Fallibility of clinical symptoms and signs. Archives of Surgery 1976; 111: 34-36
Contributor: Bob Phillips and Clare Wotton, June 2000
Reviewer:

Clinical Question.
Patient suspected DVT
Intervention or Exposure Homan's sign
Outcome diagnosis of DVT