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Lower-extremity Doppler for deep venous thrombosis--can emergency physicians be accurate and fast?
M Blaivas1, M J Lambert, R A Harwood
1Department of Emergency Medicine, Christ Hospital and Medical Center, Milwaukee, WI, USA. blaivas@pyro.net
Summary
Emergency physicians can accurately and quickly diagnose deep venous thrombosis (DVT) using lower-extremity (LE) duplex ultrasound. This rapid diagnostic capability in the emergency department improves patient care for suspected DVT.
Area of Science:
- Emergency Medicine
- Vascular Ultrasound
- Diagnostic Imaging
Background:
- Clinical diagnosis of lower-extremity deep venous thrombosis (DVT) requires imaging confirmation.
- Ultrasound vein compressibility is accurate for DVT diagnosis by specialists.
- Lower-extremity Doppler ultrasound is preferred but not always available.
Purpose of the Study:
- Evaluate the accuracy and speed of lower-extremity color duplex ultrasonography performed by emergency physicians for DVT detection.
Main Methods:
- Prospective study in an urban emergency department (ED) from August 1998 to March 1999.
- Emergency physicians with brief training performed LE color duplex ultrasound with compression on high-risk patients.
- ED scan completion time was recorded; vascular laboratory performed a complete study within eight hours.
Main Results:
- 112 patients enrolled; 34 tested positive for DVT.
- Median ED examination time was 3 minutes 28 seconds.
- ED results showed high correlation (kappa=0.9) and 98% agreement with vascular laboratory studies.
Conclusions:
- Emergency physicians can perform lower-extremity duplex ultrasound examinations accurately and quickly.
- This technique is a viable option for DVT diagnosis in the emergency department setting.