Optimizing Lower Extremity Duplex Ultrasound Screening After Traumatic Injury

Trauma patients at risk for venous thromboembolism who undergo routine duplex ultrasound screening experience fewer pulmonary emboli: A prospective randomized trial

“…46,47 Indeed, there were four PE subjects in this study who did not have an associated DVT on DUS, suggesting a limitation of the ability of a DUS study to provide an opportunity for intervention that could impact PE incidence. However, most PEs are still associated with a DVT 24,48 including 60% of PE patients in this study, supporting the use of surveillance for early identification and management of DVTs. Because both the US and NoUS groups were well matched with regard to early timing and type of adequate chemoprophylaxis, but a lower rate of PE was found in the US group, our data suggest an association between identifying (and managing) asymptomatic DVT and a lower rate of PE.…”

“…It has since been validated as an appropriate tool, and a score of ≥5 has been associated with a threefold risk of VTE compared with a score of <5 8,30 . Baker and colleagues 24 found that increasing the RAP threshold from ≥5 to ≥8 for routine surveillance resulted in similar positivity rates for both DVT and PE, thus reducing cost without compromising outcomes 25 . Alternatively, others have identified DVT rates as high as 13% in patients with a RAP score of <5 and caution its sole use to guide diagnostic strategy 20,40 .…”

“…The literature addressing the role of DUS screening in asymptomatic trauma patients is fraught with mixed findings regarding its clinical impact and has resulted in vigorous debate weighing allocation of resources against high-quality patient care. Some groups have found value in the early diagnosis and management of DVT in high-risk trauma patients, [23][24][25][26][27][28][29] while others cite the high cost of routine screening with a low clinical yield. [19][20][21][22] While the outcome of interest is primarily PE, some argue that DVT itself a major complication warranting surveillance for early detection given recognized clinical sequelae including recurrent VTE and postthrombotic syndrome.…”

“…The utility and cost-effectiveness of lower extremity duplex ultrasound (DUS) screening protocols in trauma have engendered debate, specifically regarding who warrants screening, how often to screen, and, most importantly, whether routine surveillance impacts clinically important VTE outcomes. [19][20][21][22][23][24][25][26][27][28][29] Formerly, our institution practiced routine surveillance DUS for trauma patients at risk for VTE resulting in measured VTE rates as a high outlier in our quality reporting. The declaration of VTE as a quality measure created a negative incentive to routinely assess for DVT, which led to an administrative suggestion to cease routine surveillance as a "fix" to our VTE rates.…”

Effect Analysis of Nursing Intervention on Lower Extremity Deep Venous Thrombosis in Patients

“…Furthermore, the first-line examination of choice for DVT, the venous duplex ultrasounds, has replaced venography with improved efficiency and decreased patient sensitivity to radiation and intravenous comparison (Bahar et al,2019). An abbreviated ultrasound where DVT is derived from imperfect venous compressibility has the same precision as a venous duplex that needs less time and experience for an emergency, vital, and anesthesia clinician to allow its widespread usage (Baker et al, 2019). The author investigated the early functional mobilization (EFM), increased patient satisfaction with immediate post-operative weight bearings, and ankle mobility relative to immobilization of ATR patients if EFM will minimize DVT incidences; however, it is not established (Ellis et al, 2019).…”