Deep venous thrombosis: diagnosis in spinal cord injured patients

Because the acute spinal cord injured patient is at high risk for the development of deep venous thrombosis (DVT), accurate diagnosis is critical. Clinical evaluation is unreliable 50% of the time, however, and the two highly accurate diagnostic procedures--venography and 125I-labelled fibrinogen scanning--are invasive and present serious drawbacks. The literature concerning the effectiveness of the two most widely used noninvasive diagnostic alternatives (Doppler ultrasound and venous occlusion plethysmography [VOP]) is equivocal. In our systematic evaluation of a series of 21 patients, using clinical examination, Doppler ultrasound and VOP, all patients who developed DVT were identified by all three methods. Overall accuracy, sensitivity and specificity were 100%.