Evaluation of a screening protocol to exclude the diagnosis of deep venous thrombosis among emergency department patients

Abstract

A screening protocol using PTP along with selective D-dimer and VDI to exclude the diagnosis of DVT among ED patients is efficacious and cost efficient. This screening approach establishes criteria to satisfy billing requirements, can eliminate unnecessary VDI in 23% of ED referrals, and can reduce charges by 16%.

Early thrombus removal strategies for acute deep venous thrombosis: Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum

“…If iliofemoral venous thrombosis is suspected but not confirmed using standard diagnostic modalities such as venous ultrasound imaging, we recommend the use of adjunctive imaging modalities, such as computed tomography venography or magnetic resonance venography to characterize the most proximal thrombus extent (Grade 1C). Several strategies for the diagnosis of DVT, incorporating combinations of clinical risk stratification, 33,34 measurement of D-dimer levels, [35][36][37][38][39] and venous ultrasound imaging, have been developed. As a component of such strategies, venous ultrasound imaging has become the most important diagnostic test for acute DVT.…”

Review of the Evidence on Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism

“…The sensitivities and specifi cities of the rule (at each cutoff) refl ect how correctly the rule predicts the presence or absence of disease. We identifi ed 19 studies that evaluated clinical prediction rules for the diagnosis of DVT, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] and 8 studies evaluating clinical prediction rules for the diagnosis of pulmonary embolism, [35][36][37][38][39][40][41][42] although common patients were reported in 3 studies. [40][41][42] (Supplemental Appendix 1, available online at http://www.annfammed.org/cgi/content/full/5/1/63/DC1).…”

Mapping the future: Organizational, clinical, and research priorities in venous disease

“…Most validated strategies for the diagnosis of acute DVT have limited examination to compression of the proximal veins and have required either serial examinations 18,19 or combined algorithms including D-dimer measurement and clinical risk stratification. [20][21][22][23] Despite encouraging preliminary data, 24,25 the accuracy of a single, technically adequate duplex scan, including the calf veins, has not yet been sufficiently validated.…”