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Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Common alternative diagnoses in general practice when deep venous thrombosis is excluded
A J ten Cate-Hoek1, E F van der Velde, D B Toll
1Maastricht University, School of Public Health and Primary Care (CAPHRI), Department of Epidemiology, Academic Hospital Maastricht, Maastricht, the Netherlands. arina.tencate@epid.unimaas.nl
The Netherlands Journal of Medicine
|April 21, 2012
Summary
In primary care, most patients initially suspected of deep venous thrombosis (DVT) receive alternative diagnoses. A wait-and-see approach is safe for many, but superficial venous thrombosis (SVT) requires closer monitoring due to potential links with DVT.
Area of Science:
- Vascular Medicine
- Primary Care Diagnostics
- Diagnostic Accuracy
Background:
- Deep venous thrombosis (DVT) is initially suspected in many primary care patients, but confirmed in only 10-30%.
- The majority of patients initially suspected of DVT are eventually assigned an alternative diagnosis.
- Understanding these alternative diagnoses and their management is crucial for effective primary care.
Purpose of the Study:
- To determine the frequency distribution of alternative diagnoses in primary care patients after excluding DVT.
- To assess the subsequent management strategies for these patients.
- To evaluate the utility of ultrasound examination in diagnosing alternative conditions.
Main Methods:
- Data collected by general practitioners in the Netherlands (AMUSE study) were analyzed.
- A three-month follow-up questionnaire provided additional patient management data.
- Descriptive analysis was performed on the combined dataset.
Main Results:
- The most common alternative diagnoses included muscle rupture (18.5%), chronic venous insufficiency (CVI) (14.6%), erysipelas/cellulitis (12.6%), and superficial venous thrombosis (SVT) (10.9%).
- Ultrasound examination did not significantly improve the diagnostic yield for alternative diagnoses.
- A 'wait and see' approach was employed in approximately 30% of cases; 9 patients developed venous thromboembolic disease within three months, with 3 originating from the SVT group (p=0.026).
Conclusions:
- A 'wait and see' policy is generally safe for patients with excluded DVT in primary care.
- Patients diagnosed with superficial venous thrombosis (SVT) warrant closer surveillance due to a significant association with underlying thrombosis.
- Ultrasound's role in diagnosing alternative conditions in this setting needs further evaluation.
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