Isolated Deep Venous Thrombosis: Implications for 2-Point Compression Ultrasonography of the Lower Extremity

Adhikari, Srikar; Zeger, W.; Thom, Christopher; Fields, J. Matthew

doi:10.1016/j.annemergmed.2014.10.032

Cited by 54 publications

(35 citation statements)

References 10 publications

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“…We identified all ED patients who received a comprehensive lower extremity venous duplex ultrasound examination during the study period using current procedural terminology (CPT) code for lower extremity venous duplex US examination from our DVT research database. 14 In the ED, clinical assessment was performed by emergency medicine residents and faculty. All subjects also underwent a single comprehensive lower extremity duplex venous US (B-mode and Doppler) for evaluation of DVT in the ED.…”

Section: Methodsmentioning

confidence: 99%

Non-thrombotic Abnormalities on Lower Extremity Venous Duplex Ultrasound Examinations

Adhikari¹,

Zeger

2015

WestJEM

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IntroductionEmergency physician-performed compression ultrasonography focuses primarily on the evaluation of the proximal veins of the lower extremity in patients with suspected deep venous thrombosis (DVT). A detailed sonographic evaluation of lower extremity is not performed. The objective of this study was to determine the prevalence of non-thrombotic findings on comprehensive lower extremity venous duplex ultrasound (US) examinations performed on emergency department (ED) patients.MethodsWe performed a retrospective six-year review of an academic ED’s records of adult patients who underwent a comprehensive lower extremity duplex venous US examination for the evaluation of DVT. The entire US report was thoroughly reviewed for non-thrombotic findings.ResultsWe detected non-thrombotic findings in 263 (11%, 95% CI [9.5–11.9%]) patients. Among the non-thrombotic findings, venous valvular incompetence (81, 30%) was the most frequent, followed by cyst/mass (41, 15%), lymphadenopathy (33, 12%), phlebitis (12, 4.5%), hematoma (8, 3%), cellulitis (1, 0.3%) and other (6, 2.2%).ConclusionIn our study, we detected a variety of non-thrombotic abnormalities on comprehensive lower extremity venous duplex US examinations performed on ED patients. Some of these abnormalities could be clinically significant and potentially be detected with point-of-care lower extremity US examinations if the symptomatic region is evaluated. In addition to assessment of the proximal veins for DVT, we recommend sonographic evaluation of the symptomatic area in the lower extremity when performing point-of-care ultrasound examinations to identify non-thrombotic abnormalities that may require immediate intervention or close follow up.

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Section: Methodsmentioning

confidence: 99%

Non-thrombotic Abnormalities on Lower Extremity Venous Duplex Ultrasound Examinations

Adhikari¹,

Zeger

2015

WestJEM

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“…Among different lower extremity proximal veins, our subjects had diffi culty with the deep femoral vein, as seen with the lowest handson scores for identifying that anatomy. However, the prevalence of isolated deep femoral vein DVTs is less than 1%, [5] so perhaps this skill may not be critical.…”

Section: Discussionmentioning

confidence: 99%

“…Adding D-dimer to the evaluation results in false positives, leading to unnecessary revisits and repeat ultrasound examinations, ultimately increasing resource utilization. Adhikari et al [5] found that 6% of emergency department (ED) patients with suspected DVT had isolated thrombi in the femoral vein, which is not evaluated in the above techniques. Extended compression ultrasound (ECUS) evaluates the entire femoral vein from the femoral/deep femoral vein bifurcation to the adductor canal.…”

Section: Introductionmentioning

confidence: 99%

Can emergency physicians perform extended compression ultrasound for the diagnosis of lower extremity deep vein thrombosis?

Situ-LaCasse

Guirguis

Friedman

et al. 2019

World Journal of Emergency Medicine

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“…In these patients, a combined heart and lung POCUS can identify the cause of dyspnea in most of the cases or significantly narrow the range of diagnoses [26,33,34]. In addition to heart and lung POCUS, lower extremity vein POCUS can be used to accurately identify proximal deep venous thrombosis (DVT) [12,45], which might cause pulmonary embolus and be the cause of shortness of breath or cardiovascular collapse. A multi-organ POCUS of the heart, lungs, and lower extremity veins has already been tested in a randomized trial with respiratory patients from the emergency department, reporting superiority of POCUS to standard diagnostic tests alone for establishing a correct diagnosis within 4 h [27].…”

Section: Introductionmentioning

confidence: 99%

Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission: study protocol of a randomized controlled trial—the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study

Cid

Canty

Royse

et al. 2020

Trials

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Background: Point-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision-making as well as timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. However, there is still an evidence gap in all the medical setting of how its use affects clinical variables such as length of stay, morbidity, and mortality. Methods/design: A prospective randomized controlled trial assessing the effect of a surface POCUS of the heart, lungs, and femoral and popliteal veins performed by an internal medicine physician during the first 24 h of patient admission to the unit with a presumptive cardiopulmonary diagnosis. The University of Melbourne iHeartScan, iLungScan, and two-point venous compression protocols are followed to identify left and right ventricular function, significant valvular heart disease, pericardial and pleural effusion, consolidation, pulmonary edema, pneumothorax, and proximal deep venous thrombosis. Patient management is not commanded by the protocol and is at the discretion of the treating team. A total of 250 patients will be recruited at one tertiary hospital. Participants are randomized to receive POCUS or no POCUS. The primary outcome measured will be hospital length of stay. Secondary outcomes include the change in diagnosis and management, 30-day hospital readmission, and healthcare costs. Discussion: This study will evaluate the clinical impact of multi-organ POCUS in internal medicine patients admitted with cardiopulmonary diagnosis on the hospital length of stay. Recruitment of participants commenced in September 2018 and is estimated to be completed by March 2020.

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Isolated Deep Venous Thrombosis: Implications for 2-Point Compression Ultrasonography of the Lower Extremity

Cited by 54 publications

References 10 publications

Non-thrombotic Abnormalities on Lower Extremity Venous Duplex Ultrasound Examinations

Non-thrombotic Abnormalities on Lower Extremity Venous Duplex Ultrasound Examinations

Can emergency physicians perform extended compression ultrasound for the diagnosis of lower extremity deep vein thrombosis?

Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission: study protocol of a randomized controlled trial—the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study

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