Outcome analysis of patients with normal compression US examinations

Prior studies have documented the accuracy of compression ultrasound (US) for use in evaluating patients with clinically suspected deep venous thrombosis (DVT) of the lower extremity. A normal compression US examination is considered indicative of no thrombotic disease, and anticoagulant therapy is withheld. There are no long-term data supporting treatment decisions based solely on normal compression US results. The authors undertook a long-term (8-33-month) review of 1,111 normal compression US examinations performed on 1,022 patients. Outcome analysis obtained through review of imaging records, inpatient charts, and death certificates failed to document sequelae of untreated DVT in all but five patients with negative examinations. Three patients again presented with clinical symptoms of DVT that were subsequently documented with compression US, and two patients reportedly died of pulmonary embolism with no documentation of DVT several months after the initial negative study. Because of the clinical acceptance of this test and the subsequent increased demand for its use, compression US has quadrupled the yearly detection rate of DVT at the authors' institution. With the results of prior controlled studies and this favorable outcome analysis study, compression US is recommended as the diagnostic modality of choice for suspected DVT.