Low Accuracy of Color Doppler Ultrasound in the Detection of Proximal Leg Vein Thrombosis in Asymptomatic High-Risk Patients

Davidson, Bruce L.; Elliott, C. Gregory; Lensing, Anthonie W. A.

doi:10.7326/0003-4819-117-9-735

Cited by 201 publications

(66 citation statements)

References 14 publications

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“…Although ultrasound can be carried out at the bedside non‐invasively without contrast material, the diagnostic accuracy is extremely sensitive to the experience of the examiner 19. Also, associated injuries often limit the complete screening, which possibly leads to poor accuracy in the detection of DVT 20. Combined CT pulmonary angiography and CT venography, as used in our study, have advantages over ultrasound in terms of one test for both DVT and pulmonary embolism and high diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 91%

Venous thromboembolism in major trauma patients: a single‐center retrospective cohort study of the epidemiology and utility of D‐dimer for screening

Yumoto

Naito

Yamakawa

et al. 2017

Acute Medicine & Surgery

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AimVenous thromboembolism (VTE) can be a life‐threatening complication after major trauma. The aim of this study was to investigate the epidemiology of VTE and to assess the usefulness of D‐dimer for screening for VTE in major trauma cases among the Japanese population.MethodsWe examined a single‐center retrospective cohort of severely injured trauma patients who had been admitted to the emergency intensive care unit at Okayama University Hospital (Okayama, Japan) from April 2013 through to March 2016. Venous thromboembolism was confirmed by computed tomography angiography and computed tomography venography, which was determined based on the attending physician monitoring daily D‐dimer levels. Independent risk factors for VTE were determined by multiple logistic regression analysis. D‐dimer levels were evaluated using area under the receiver operating characteristic curve (AUROC) to predict VTE.ResultsThe study cohort consisted of 204 trauma patients (median Injury Severity Score, 20). Of the 204 patients, 65 (32%) developed VTE. The median time from admission to VTE diagnosis was 10 days. In multiple logistic regression analysis, higher Injury Severity Score and the presence of lower extremity fractures were revealed to be a risk factor for VTE. D‐dimer levels at day 10 showed moderate accuracy, of which the AUROC was 0.785 (95% confidence interval, 0.704–0.866; P < 0.001). The cut‐off that maximized the Youden index was 12.45 μg/mL.ConclusionsAt least one of every three major trauma patients had potential development of VTE at a median of 10 days following admission to the intensive care unit. D‐dimer levels on day 10 can be a useful predictor of VTE.

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Section: Discussionmentioning

confidence: 91%

Venous thromboembolism in major trauma patients: a single‐center retrospective cohort study of the epidemiology and utility of D‐dimer for screening

Yumoto

Naito

Yamakawa

et al. 2017

Acute Medicine & Surgery

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“…Ultrasound tests in asymptomatic patients are insufficiently accurate [3,4]. The moderate sensitivity of these tests might be compensated for by enrolling additional patients (as proposed for unilateral venography) -if test results were extremely specific, however, they are not.…”

Section: Which Test?mentioning

confidence: 99%

What Are the Most Reliable Detection Methods for Deep Vein Thrombosis and Pulmonary Embolism to be Used as Endpoints in Trials of Venous Thromboprophylaxis?

Davidson¹

1998

Pathophysiol Haemos Thromb

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Numerous considerations and controversies attend the question of which endpoints to use in venous thromboembolism prophylaxis trials. In this paper, a rationale is presented for a new approach that simplifies certain aspects of endpoint detection in deep vein thrombosis and pulmonary embolism trials, and complicates others. The goal of this approach is to use reliably ascertainable endpoints that are clinically relevant and most probably predictive of clinical efficacy, in order to optimally inform the drug development process.

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“…It is clearly appropriate to screen such patients prior to discharge using an objective diagnostic test. A number of recent studies have found both IPG and duplex imaging to be inadequate for the diag nosis of asymptomatic DVT in surveillance studies, particularly following hip replace ment operations [38,60]. These investigators recommend either venography prior to dis charge or continuation of prophylaxis into the outpatient setting.…”

Section: Asymptomatic High-risk Patientsmentioning

confidence: 99%

Diagnostic Methods for Deep Vein Thrombosis

Wheeler¹,

Anderson²

1995

Pathophysiol Haemos Thromb

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Clinical diagnosis of deep vein thrombosis (DVT) is unreliable, and treatment should not be undertaken without objective confirmation. The traditional ‘gold standard’ for the diagnosis of DVT has been venography, but ultrasonic imaging has now replaced venography as the new diagnostic standard in many hospitals. A variety of noninvasive physiologic tests are also useful in selected circumstances. These include plethysmography, Doppler flow studies, radioisotope tests, thermography and peripheral blood tests which reflect activation of coagulation or thrombolysis. We describe the clinical application of these diagnostic procedures, both for symptomatic patients suspected to have DVT and for asymptomatic patients at high risk for DVT. The selection of an appropriate diagnostic modality depends upon institutional capabilities, cost-effectiveness and individual patient circumstances.

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Low Accuracy of Color Doppler Ultrasound in the Detection of Proximal Leg Vein Thrombosis in Asymptomatic High-Risk Patients

Abstract: Color Doppler ultrasound examinations are insensitive to proximal DVT in asymptomatic high-risk patients and should not be substituted for venography for identifying proximal DVT in such patients.

Cited by 201 publications

References 14 publications

Venous thromboembolism in major trauma patients: a single‐center retrospective cohort study of the epidemiology and utility of D‐dimer for screening

Venous thromboembolism in major trauma patients: a single‐center retrospective cohort study of the epidemiology and utility of D‐dimer for screening

What Are the Most Reliable Detection Methods for Deep Vein Thrombosis and Pulmonary Embolism to be Used as Endpoints in Trials of Venous Thromboprophylaxis?

Diagnostic Methods for Deep Vein Thrombosis

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