Validation of the 3D SYM VEIN Symptom Assessment Tool
Background: There is an unmet need for a disease-specific symptom scoring tool in patients with chronic venous disease (CVD). The SYM VEIN consensus statement has recently proposed a three-dimensional (3D) system that takes into account not only symptom severity, but also individual frequency and daily course (sum of the three attributes, each graded on a 0-3 scale, for a maximum of 9 points).
Objectives: To prospectively validate the SYM VEIN consensus 3D scoring tool in patients with CVD undergoing saphenectomy and compare it with established outcome measures.
Methods: Patients with CVD undergoing saphenectomy were assessed preoperatively using the revised Venous Clinical Severity Score (r-VCSS), the CIVIQ questionnaire of life (validated Greek version), and the 3D score (for each individual symptom and in the form of a total of each score), preoperatively and at four weeks postoperatively. We assessed the symptoms of pain or aching, heaviness, sensation of edema, burning pain, cramps, restless legs, paresthesia, throbbing pain and pruritus and performed principal component analysis of the 3D scores to identify highly inter-correlating variables and groups of symptoms. Finally, we performed multiple regression to identify independent symptoms as predictors of quality of life.
Results: A total of 31 consecutive patients with CVD (20 females, mean age 55 years, CEAP clinical class range 2-6) were included in the present study. 3D scores of the symptoms, r-VCSS and CIVIQ score are shown in the Table. Median r-VCSS was reduced from 6 to 0 (100% decrease, p<0.001), total 3D score was reduced from 29 to 5 (82% decrease, p<0.001), and CIVIQ score was reduced from 24 to 15 (26% decrease, p<0.001). The difference of median percentage changes between VCSS and total 3D score was significant (p=0.006). Principal component analysis identified three groups of symptoms that showed high intragroup correlation. The first one included aching, burning pain, cramps and sensation of edema, the second one restless leg and throbbing pain and the third one paresthesia. Multiple regression identified cramps and heaviness as independent predictors of the CIVIQ quality of life score, p=0.009 and 0.017, respectively.
Conclusions: This is the first validation of the SYM VEIN consensus 3D scoring tool in patients with CVD. The total 3D score is less prone to change after saphenectomy compared to r-VCSS, possibly a result of better ability to score residual symptoms. Larger studies are required to assess the intercorrelation of venous symptoms and their effect on quality of life.
To be considered for the EVF Prize.