Systematic review of emergency physician-performed ultrasonography for lower-extremity deep vein thrombosis

Patrick R. Burnside, Michael D. Brown, Jeffrey A. Kline

Research output: Contribution to journalArticle

68 Scopus citations

Abstract

Objectives: The authors performed a systematic review to evaluate published literature on diagnostic performance of emergency physician-performed ultrasonography (EPPU) for the diagnosis and exclusion of deep venous thrombosis (DVT). Methods: Structured search criteria were used to query MEDLINE and EMBASE, followed by a hand search of published bibliographies. Relevance and inclusion criteria required prospective investigation of emergency department (ED) outpatients with suspected DVT; diagnostic evaluations had to consist of EPPU followed by criterion standard (radiology-performed) imaging. Two authors independently extracted data from included studies; study quality was assessed utilizing a validated tool for quality assessment of diagnostic accuracy studies (QUADAS). Pooled data were analyzed using an unweighted summary receiver-operating-characteristic (SROC) curve; sensitivity and specificity were estimated using a random effects model. Results: The initial search yielded 1,162 publications. Relevance screening and selection yielded six articles including 936 patients. Four of the six studies reported adequate blinding but a number of other methodologic flaws were identified. A random effects model yielded an overall sensitivity of 0.95 (95% confidence interval [CI] = 0.87 to 0.99) and specificity of 0.96 (95% CI = 0.87 to 0.99). Conclusions: Systematic review of six studies suggests that EPPU may be accurate for the diagnosis of DVT compared with radiology-performed ultrasound (US). However, given the methodologic limitations identified among the primary studies, the estimates of diagnostic test performance may be overly optimistic. Further research into EPPU for suspected DVT is needed before it can be adopted into routine clinical practice.

Original languageEnglish (US)
Pages (from-to)493-498
Number of pages6
JournalAcademic Emergency Medicine
Volume15
Issue number6
DOIs
StatePublished - Jun 1 2008
Externally publishedYes

Keywords

  • Deep vein thrombosis
  • Emergency department
  • Systematic review
  • Ultrasound

ASJC Scopus subject areas

  • Emergency Medicine

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