APPROPRIATE INDICATIONS FOR VENOUS DUPLEX ULTRASONOGRAPHIC EXAMINATIONS

Citation
Jl. Glover et Pj. Bendick, APPROPRIATE INDICATIONS FOR VENOUS DUPLEX ULTRASONOGRAPHIC EXAMINATIONS, Surgery, 120(4), 1996, pp. 725-730
Citations number
15
Categorie Soggetti
Surgery
Journal title
ISSN journal
00396060
Volume
120
Issue
4
Year of publication
1996
Pages
725 - 730
Database
ISI
SICI code
0039-6060(1996)120:4<725:AIFVDU>2.0.ZU;2-L
Abstract
Background. Because of the rapid growth in requests for lower extremit y venous duplex ultrasonographic examinations, we have evaluated test results to determine the approximate indications for testing and wheth er there is overuse of this technique. Methods. We reviewed the record s of all patients who had duplex ultrasonogram during an 18-month peri od to rule out deep vein thrombosis (DVT). Test outcome was evaluated with data on the age, gender, outpatient or inpatient status, duration of symptoms, physical findings, and risk factors of the patients. Res ults. We reviewed 3474 examinations; 1265 outpatients and 1231 inpatie nts were evaluated to rule wt DVT, and 978 patients were evaluated to rule out a source of pulmonary embolism. More outpatients were female, and they tended to be younger; outpatients also had more acute femoro popliteal DVT. The presence of sudden onset of unilateral swelling was a strong predictor of acute DVT in all three groups: 52% of such pati ents were found to have DVT. Mild unilateral symptoms with a. coexiste nt risk factor was associated with a 10% to 20% prevalence of acute DV T. Chronic unilateral swelling was associated with acute DVT only with a coexistent risk factor and only in 1% of such patients. Bilateral s welling was only associated with acute DVT in the inpatient population , with 17% of studies having positive results. If calf tenderness was the only symptom with no associated risk factors, seven (1.6%) of 415 patients had acute DVT and six of these were tibioperoneal. No patient s with cellulitis or isolated joint pain had acute DVT. With clinicall y suspected pulmonary embolism in patients without associated symptoms or risk factors, 7 (1.5%) of 447 studies showed tibioperoneal disease with no acute femoropopliteal disease. Conclusions. The physical exam ination and clinical history of the patient re-main important indicato rs Of the presence (or absence) of lower extremity DVT and can guide t he appropriate use of duplex ultrasonography for the diagnosis.