IMPEDANCE PLETHYSMOGRAPHY AS A SCREENING-PROCEDURE FOR ASYMPTOMATIC DEEP VENOUS THROMBOSIS IN A REHABILITATION HOSPITAL

Objective: Patients admitted for an inpatient rehabilitation treatment program almost uniformly have an elevated risk of deep venous thrombo sis (DVT) and pulmonary embolism (PE), We assessed the value of impeda nce plethysmography (IPG) as a screening procedure for asymptomatic de ep venous thrombosis in a series of patients admitted to our instituti on, Design: Using a prospective observational study design, consecutiv e admissions to our facility for a period of almost one year were subj ected to IPG within several days of admission, Setting: The study site was a 60-bed hospital-based rehabilitation center, Patients: Four hun dred eighty-three consecutive patients were studied prospectively with in several days of admission, Diagnoses included a variety of neurolog ical disorders that resulted in significant weakness, intracranial sur gery, orthopedic surgical procedures and fractures, joint replacements , and nonorthopedic postsurgical deconditioning. Three hundred eightee n patients were available for three-month follow-up, Interventions: IP G was successfully completed in 301 patients. If IPG was positive, DVT was further assessed by duplex ultrasound (DU), When IPG and DU confi rmed the presence of a DVT, administration of heparin and Coumadin was begun, Main Outcome Measures: Thirteen of 416 attempted IPG studies w ere positive for DVT, whereas DU confirmed the diagnosis in only 3 pat ients, Results: Follow-up found that six patients developed DVT or PE before discharge from our institution; five patients developed DVT or PE after discharge, Conclusions: IPG has a poor yield as a screening t ool for asymptomatic DVT on admission to an inpatient rehabilitation f acility, The sensitivity and positive predictive value of IPG was too low to advocate its routine use in this setting. (C) 1995 by the Ameri can Congress of Rehabilitation Medicine and the American Academy of Ph ysical Medicine and Rehabilitation