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Updated: Jun 26, 2025
Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Bilateral lower limb examinations for deep vein thrombosis: A single-centre pilot study comparing request and report
Insights
Bilateral deep vein thrombosis (DVT) ultrasound referrals are eight times less likely to detect a DVT compared to single leg referrals. Further research is needed to optimize DVT diagnostic protocols and resource allocation.
Area of Science:
- Medical Imaging
- Vascular Ultrasound
- Diagnostic Procedures
Background:
- Deep vein thrombosis (DVT) is a prevalent condition with serious health implications.
- Current ultrasound guidance in the UK primarily focuses on single leg referrals for DVT diagnosis.
- The diagnostic yield and optimal protocol for bilateral DVT examinations remain under-investigated.
Purpose of the Study:
- To compare the diagnostic yield and request/report parameters of bilateral leg ultrasound examinations versus single leg examinations for DVT.
- To inform the development of standardized ultrasound protocols for DVT diagnosis.
Main Methods:
- A single-center feasibility study analyzed data from 630 lower limb ultrasound examinations over six months.
- Data included referral details and ultrasound findings for both single and bilateral leg examinations.
- Statistical methods were used to compare DVT detection rates based on laterality and other factors.
Main Results:
- Out of 630 examinations, only 18 were bilateral.
- Single leg referrals were over eight times more likely to yield a positive DVT diagnosis compared to bilateral referrals.
- Significant differences in DVT yield were observed between single and bilateral examination groups.
Conclusions:
- Bilateral DVT ultrasound examinations demonstrate a significantly lower diagnostic yield than single leg examinations.
- The findings suggest a need to re-evaluate current ultrasound protocols and resource allocation for DVT diagnosis.
- Further research is required to validate these results and establish criteria for bilateral DVT referrals.
Introduction:
Deep vein thrombosis (DVT) is a common pathology with significant morbidity and mortality, often occurring in the lower limb. Ultrasound is the modality of choice for diagnosis of DVT, but all guidance in the United Kingdom assumes a single leg referral. Few studies have addressed the question of bilateral referrals and bilateral DVTs, and it is not known how these should be included in ultrasound protocols. This study aims to compare the request and report parameters of bilateral examinations with those for single leg examinations over a six-month period.
Methods:
A single-centre feasibility study collected data on all single and bilateral leg examinations performed by sonographers, over a six-month period at a small general hospital. Data collected for each examination included the referral and report findings. These were compared using basic statistical methods to compare DVT yield by laterality, referrer, DVT site, and patient factors.
Results:
Six hundred and thirty examinations were included, eighteen of which were bilateral examinations. Although the bilateral leg cohort was small, there were significant differences in DVT yield between the groups, with single leg referrals more than eight times more likely to demonstrate a DVT at ultrasound.
Conclusion:
In a context of limited ultrasound resource, the low DVT yield of bilateral examinations has implications for service design. Further data collection will be needed to validate initial results, and to establish suitable criteria for acceptance of bilateral DVT referrals.
Implications For Practice:
Low yield of DVTs in bilateral examinations can be validated via further research. Bilateral examinations can be explicitly included in DVT service design.
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