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Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
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Delayed Venous Thromboembolism Diagnosis and Mortality Risk
Min-Jeoung Kang1,2, Richard Schreiber3, Veysel Karani Baris1,4
1Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA Network Open
|September 26, 2025
Summary
High rates of diagnostic delay in venous thromboembolism (VTE) were observed, with delayed diagnosis significantly increasing mortality risk. The DOVE eCQM tool can aid quality improvement efforts for VTE diagnosis.
Area of Science:
- Medical Informatics
- Clinical Quality Measurement
- Public Health
Background:
- Nonspecific symptoms of venous thromboembolism (VTE) complicate early detection.
- Automated tools for monitoring VTE diagnostic delays are currently lacking.
- Timely VTE diagnosis is critical for patient outcomes.
Purpose of the Study:
- To evaluate diagnostic delay of VTE (DOVE) rates across two healthcare systems with different EHRs.
- To categorize the reasons for missed VTE diagnoses.
- To assess the association between diagnostic delays and 30-day all-cause mortality.
Main Methods:
- Retrospective analysis of electronic health record (EHR) data from Mass General Brigham (MGB) and Penn State Health (PSH).
- Development and application of an electronic clinical quality measure (eCQM) to quantify DOVE.
- Comparison of 30-day all-cause mortality between timely (≤24 hours) and delayed (>24 hours) VTE diagnoses.
Main Results:
- High DOVE rates were observed: 79.43% (MGB) and 82.38% (PSH) using a >24-hour threshold.
- Practitioner-related factors were the most common cause of diagnostic delays.
- Delayed VTE diagnosis was associated with increased 30-day all-cause mortality (RR 3.31 at MGB; RR 1.28 at PSH).
Conclusions:
- Consistently high DOVE rates indicate a significant challenge in timely VTE diagnosis.
- The DOVE eCQM tool is valuable for identifying and addressing diagnostic delays.
- Implementation of the DOVE eCQM can support quality improvement initiatives at multiple healthcare levels.
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