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A critical pathway to evaluate suspected deep vein thrombosis
S D Pearson1, J L Polak, S Cartwright
1Department of Medicine, Brigham and Women's Hospital, Boston, Mass., USA.
Archives of Internal Medicine
|September 11, 1995
Summary
This study introduces a new critical pathway for evaluating deep vein thrombosis (DVT) in emergency departments. The guideline standardizes care, aiming for faster diagnosis and treatment of DVT.
Area of Science:
- Emergency Medicine
- Vascular Medicine
- Clinical Guidelines
Background:
- Variations in deep vein thrombosis (DVT) evaluation practices exist, impacting care quality and efficiency.
- Standardized protocols are needed to optimize the diagnostic process for suspected DVT.
Purpose of the Study:
- To develop and present a critical pathway guideline for emergency department evaluation of suspected DVT.
- To address practice variations and improve the efficiency and quality of DVT care.
Main Methods:
- Multidisciplinary team development using chart review, institutional benchmarking, and literature review.
- Consensus on ultrasound as the primary imaging modality.
- Recommendations for higher initial heparin sodium doses to expedite therapeutic anticoagulation.
Main Results:
- Established a target patient evaluation time of 5 hours or less.
- Identified areas of controversy: managing high clinical suspicion with normal ultrasound and evaluating isolated calf-vein DVT.
- The pathway balances standardization with physician-led, patient-specific decision-making.
Conclusions:
- The developed critical pathway provides a standardized approach to DVT evaluation in the emergency department.
- The guideline aims to enhance diagnostic efficiency and therapeutic effectiveness while accommodating clinical judgment.