C0306 Accuracy of emergency physician’ performed ultrasonography in the diagnosis of deep vein thrombosis: A systematic review and a meta-analysis of the literature

Pomero, Fulvio; Dentali, Francesco; Borretta, Valentina; Bonzini, Matteo; Melchio, Remo; Douketis, James D.; Fenoglio, Luigi

doi:10.1016/j.thromres.2012.08.252

Cited by 29 publications

(47 citation statements)

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“…Some recent studies have demonstrated a similar accuracy of compression US performed by hospitalists, radiologists, emergency physicians, or trained nurses. [9][10][11] A more rapid diagnosis, directly obtained by general practitioners in primary care, could likely improve appropriate management of DVT, avoiding in-hospital evaluations and any pretest scores or laboratory evaluations. We undertook a prospective, multicenter cohort study to assess the diagnostic accuracy of compression US performed by general practitioners given a short course of training in the diagnosis of suspected DVT of the lower limbs.…”

Section: Introductionmentioning

confidence: 99%

General Practitioner–Performed Compression Ultrasonography for Diagnosis of Deep Vein Thrombosis of the Leg: A Multicenter, Prospective Cohort Study

Mumoli

Vitale

Giorgi‐Pierfranceschi

et al. 2017

Ann Fam Med

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BACKGROUND Patients with suspected deep vein thrombosis (DVT) of the lower limb represent a diagnostic dilemma for general practitioners. Compression ultrasonography (US) is universally recognized as the best test of choice. We assessed the diagnostic accuracy of compression US performed by general practitioners given short training in the management of symptomatic proximal DVT.METHODS From May 2014 to May 2016, we evaluated in a multicenter, prospective cohort study all consecutive outpatients with suspected DVT; bilateral proximal lower limb compression US was performed by general practitioners and by physicians expert in vascular US, each group blinded to the other's findings. In all examinations with a negative or nondiagnostic result, compression US was repeated by the same operator after 5 to 7 days. Inter-observer agreement and accuracy were calculated. RESULTSWe enrolled a total of 1,107 patients. The expert physicians diagnosed DVT in 200 patients, corresponding to an overall prevalence of 18.1% (95% CI, 15.8%-20.3%). The agreement between the trained general practitioners and the experts was excellent (Cohen κ = 0.86; 95% CI, 0.84-0.88). Compression US performed by general practitioners had a sensitivity of 90.0% (95% CI, 88.2%-91.8%) and a specificity of 97.1% (95% CI, 96.2%-98.1%) with a diagnostic accuracy for DVT of 95.8% (95% CI, 94.7%-97.0%).CONCLUSIONS Our results suggest that, even in hands of physicians not expert in vascular US, compression US can be a reliable tool in the diagnosis of DVT. We found that the sensitivity achieved by general practitioners appeared suboptimal, however, so future studies should evaluate the implementation of proper training strategies to maximize skill. 2017;15:535-539. https://doi.org/10.1370/afm.2109. Ann Fam Med INTRODUCTIONP atients with clinical signs and symptoms of deep vein thrombosis (DVT) of the lower limbs represent a diagnostic dilemma for general practitioners.1 Reliance on clinical findings alone can lead to misdiagnosis, unnecessary exposure to anticoagulant therapy, and high associated costs. Rapid and accurate diagnosis of DVT is therefore needed to start prompt anticoagulation therapy and reduce the risk of potentially fatal pulmonary embolism.2,3 For these reasons, in general practice, the optimal diagnostic strategy for DVT has long been debated: the Wells score is not accurate enough for use in primary care, 4 but strategies that require d-dimer testing 5 are not always accessible. Compression ultrasonography (US) is considered the more widespread method of choice for confirming or ruling out the diagnosis of DVT, and its use has been validated in several prospective studies 3,[6][7][8] 536by hospitalists, radiologists, emergency physicians, or trained nurses.9-11 A more rapid diagnosis, directly obtained by general practitioners in primary care, could likely improve appropriate management of DVT, avoiding in-hospital evaluations and any pretest scores or laboratory evaluations. We undertook a prospective, multicenter cohort study to...

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Section: Introductionmentioning

confidence: 99%

General Practitioner–Performed Compression Ultrasonography for Diagnosis of Deep Vein Thrombosis of the Leg: A Multicenter, Prospective Cohort Study

Mumoli

Vitale

Giorgi‐Pierfranceschi

et al. 2017

Ann Fam Med

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“…Currently available diagnostic techniques of thrombus imaging rely on different modalities depending on the vascular territory. For example, ultrasound is used for detection of DVT (2) and carotid stenosis (3), transesophageal echocardiography and contrast-enhanced MRI are used for cardiac chamber clots (4), and contrast medium-enhanced CT pulmonary angiography has become the gold standard for the detection of PE (5,6).…”

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confidence: 99%

¹⁸F-GP1, a Novel PET Tracer Designed for High-Sensitivity, Low-Background Detection of Thrombi

et al. 2017

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Thromboembolic diseases such as myocardial infarction, stroke, transient ischemic attacks, and pulmonary embolism are major causes of morbidity and mortality worldwide. Glycoprotein IIb/IIIa (GPIIb/IIIa) is the key receptor involved in platelet aggregation and is a validated target for therapeutic approaches and diagnostic imaging. The aim of this study was to develop and characterize a specific small-molecule tracer for PET imaging that binds with high affinity to GPIIb/IIIa receptors and has suitable pharmacokinetic properties to overcome limitations of previous approaches. Methods: Binding of 18 F-GP1 to GPIIb/IIIa receptors was investigated in competition binding assays and autoradiography using a fresh cardiac thrombus from an explanted human heart. The clot-to-blood ratio for 18 F-GP1 was investigated by an in vitro blood flow model. Biodistribution and thrombus detection was investigated in cynomolgus monkeys after insertion of a roughened catheter into either the vena cava or the aorta. Results: 18 F-GP1 is an 18 F-labeled small molecule for PET imaging of thrombi. The half maximal inhibitory concentration of 18 F-GP1 to GPIIb/IIIa was 20 nM. 18 F-GP1 bound to thrombi with a mean clot-to-blood ratio of 95. Binding was specific and can be displaced by excess nonradioactive derivative. Binding was not affected by anticoagulants such as aspirin or heparin. 18 F-GP1 showed rapid blood clearance and a low background after intravenous injection in cynomolgus monkeys. Small arterial, venous thrombi, thrombotic depositions on damaged endothelial surface, and small cerebral emboli were detected in vivo by PET imaging. Conclusions: 18 F-GP1 binds specifically with high affinity to the GPIIb/IIIa receptor involved in platelet aggregation. Because of its favorable preclinical characteristics, 18 F-GP1 is currently being investigated in a human clinical study.

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“…These studies demonstrate that a treating clinician can promptly diagnose and initiate DVT therapy, although further study is needed to validate this approach [34].…”

Section: Bedside Ultrasonographymentioning

confidence: 87%

“…A recent metaanalysis of CUS performed in the emergency department for DVT showed 94.8 % sensitivity and 96.2 % specificity [34]. These studies demonstrate that a treating clinician can promptly diagnose and initiate DVT therapy, although further study is needed to validate this approach [34].…”

Section: Bedside Ultrasonographymentioning

confidence: 93%

Expedited Management of Deep Vein Thrombosis and Acute Pulmonary Embolism

Johnson

Yarbrough

2013

Curr Emerg Hosp Med Rep

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Deep vein thrombosis and pulmonary embolism are common diseases with significant morbidity and mortality. Clinical probability assessment reliably identifies low-risk patients, and when paired with a negative D-dimer test, safely excludes venous thromboembolism. Compression ultrasonography confirms the diagnosis of deep vein thrombosis, whereas computed tomography pulmonary angiography is typically used to confirm pulmonary embolism. Risk assessment of acute pulmonary embolism stratifies low-risk patients for outpatient treatment, and high-risk patients for consideration of thrombolytic therapy. The recent approval of rivaroxaban, a novel oral anticoagulant, can simplify and expedite treatment in select patients. Ongoing clinical trials may uncover methods to prevent postthrombotic syndrome and chronic thromboembolic pulmonary hypertension. In this report, we review current diagnostic and management methods for deep vein thrombosis and pulmonary embolism.

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C0306 Accuracy of emergency physician’ performed ultrasonography in the diagnosis of deep vein thrombosis: A systematic review and a meta-analysis of the literature

Cited by 29 publications

References 0 publications

General Practitioner–Performed Compression Ultrasonography for Diagnosis of Deep Vein Thrombosis of the Leg: A Multicenter, Prospective Cohort Study

General Practitioner–Performed Compression Ultrasonography for Diagnosis of Deep Vein Thrombosis of the Leg: A Multicenter, Prospective Cohort Study

¹⁸F-GP1, a Novel PET Tracer Designed for High-Sensitivity, Low-Background Detection of Thrombi

Expedited Management of Deep Vein Thrombosis and Acute Pulmonary Embolism

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C0306 Accuracy of emergency physician’ performed ultrasonography in the diagnosis of deep vein thrombosis: A systematic review and a meta-analysis of the literature

Cited by 29 publications

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General Practitioner–Performed Compression Ultrasonography for Diagnosis of Deep Vein Thrombosis of the Leg: A Multicenter, Prospective Cohort Study

General Practitioner–Performed Compression Ultrasonography for Diagnosis of Deep Vein Thrombosis of the Leg: A Multicenter, Prospective Cohort Study

18F-GP1, a Novel PET Tracer Designed for High-Sensitivity, Low-Background Detection of Thrombi

Expedited Management of Deep Vein Thrombosis and Acute Pulmonary Embolism

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¹⁸F-GP1, a Novel PET Tracer Designed for High-Sensitivity, Low-Background Detection of Thrombi