Emergency Clinician-Performed Compression Ultrasonography for Deep Venous Thrombosis of the Lower Extremity

Jeffrey Kline, Patrick M. O'Malley, Vivek S. Tayal, Gregory R. Snead, Alice Mitchell

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Study objective: Emergency clinician-performed ultrasonography holds promise as a rapid and accurate method to diagnose and exclude deep venous thrombosis. However, the diagnostic accuracy of emergency clinician-performed ultrasonography performed by a heterogenous group of clinicians remains undefined. Methods: Prospective, single-center study conducted at an urban, academic emergency department (ED). Clinician participants included ED faculty, supervised residents, and midlevel providers who completed a training course for above-calf, 3-point-compression, venous ultrasonography. Patient participants had suspected leg deep venous thrombosis and greater than or equal to 1 predefined sign or symptom. Before any imaging, clinicians classified patients as low (40%) pretest probability of deep venous thrombosis, followed by emergency clinician-performed ultrasonography. A whole-leg reference venous ultrasonography was then performed and interpreted separately in the radiology department. Patients were followed for 30 days. The criterion standard for deep venous thrombosis(+), required thrombosis of any leg vein on a reference ultrasonograph and clinical plan to treat. Results: We enrolled 183 patients, and 27 (15%) had deep venous thrombosis(+). The sensitivity and specificity emergency clinician-performed ultrasonography was 70% (95% confidence interval [CI] 60% to 80%) and 89% (95% CI 83% to 94%), respectively, with overall diagnostic accuracy of 85% (95% CI 79% to 90%). The posterior probability of deep venous thrombosis(+) among the 88 low-risk patients with a negative emergency clinician-performed ultrasonographic result was 1 of 88, or 1.1% (95% CI 0% to 6%), and the posterior probability of deep venous thrombosis(+) among 14 high-risk patients with a positive emergency clinician-performed ultrasonographic result was 11 of 14, or 79% (95% CI 49% to 95%). Conclusion: The overall diagnostic accuracy of single-visit emergency clinician-performed ultrasonography performed by a heterogeneous group of ED clinicians is intermediate but may be improved by pretest probability assessment.

Original languageEnglish (US)
Pages (from-to)437-445
Number of pages9
JournalAnnals of Emergency Medicine
Volume52
Issue number4
DOIs
StatePublished - Oct 2008
Externally publishedYes

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Venous Thrombosis
Lower Extremity
Ultrasonography
Emergencies
Confidence Intervals
Hospital Emergency Service
Leg
Radiology
Signs and Symptoms
Veins
Thrombosis
Sensitivity and Specificity

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Emergency Clinician-Performed Compression Ultrasonography for Deep Venous Thrombosis of the Lower Extremity. / Kline, Jeffrey; O'Malley, Patrick M.; Tayal, Vivek S.; Snead, Gregory R.; Mitchell, Alice.

In: Annals of Emergency Medicine, Vol. 52, No. 4, 10.2008, p. 437-445.

Research output: Contribution to journalArticle

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abstract = "Study objective: Emergency clinician-performed ultrasonography holds promise as a rapid and accurate method to diagnose and exclude deep venous thrombosis. However, the diagnostic accuracy of emergency clinician-performed ultrasonography performed by a heterogenous group of clinicians remains undefined. Methods: Prospective, single-center study conducted at an urban, academic emergency department (ED). Clinician participants included ED faculty, supervised residents, and midlevel providers who completed a training course for above-calf, 3-point-compression, venous ultrasonography. Patient participants had suspected leg deep venous thrombosis and greater than or equal to 1 predefined sign or symptom. Before any imaging, clinicians classified patients as low (40{\%}) pretest probability of deep venous thrombosis, followed by emergency clinician-performed ultrasonography. A whole-leg reference venous ultrasonography was then performed and interpreted separately in the radiology department. Patients were followed for 30 days. The criterion standard for deep venous thrombosis(+), required thrombosis of any leg vein on a reference ultrasonograph and clinical plan to treat. Results: We enrolled 183 patients, and 27 (15{\%}) had deep venous thrombosis(+). The sensitivity and specificity emergency clinician-performed ultrasonography was 70{\%} (95{\%} confidence interval [CI] 60{\%} to 80{\%}) and 89{\%} (95{\%} CI 83{\%} to 94{\%}), respectively, with overall diagnostic accuracy of 85{\%} (95{\%} CI 79{\%} to 90{\%}). The posterior probability of deep venous thrombosis(+) among the 88 low-risk patients with a negative emergency clinician-performed ultrasonographic result was 1 of 88, or 1.1{\%} (95{\%} CI 0{\%} to 6{\%}), and the posterior probability of deep venous thrombosis(+) among 14 high-risk patients with a positive emergency clinician-performed ultrasonographic result was 11 of 14, or 79{\%} (95{\%} CI 49{\%} to 95{\%}). Conclusion: The overall diagnostic accuracy of single-visit emergency clinician-performed ultrasonography performed by a heterogeneous group of ED clinicians is intermediate but may be improved by pretest probability assessment.",
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