IMPROVED SELECTION CRITERIA FOR ORDERING STAT VENOUS ULTRASOUNDS FROMTHE EMERGENCY DEPARTMENT

BACKGROUND: The accuracy and convenience of venous ultrasound (VU) to exclude deep vein thrombosis (DVT) has led to indiscriminate use and l ow positive yield rates. METHODS: A total of 256 patients were referre d from our emergency department (ED) for stat VU during a 2-year perio d (1995 to 1996). The VUs were interpreted as normal in 198 (77%). Pos itive findings were discovered in 58 (23%), with DVT accounting for 43 (17%). Retrospective multivariant analysis was used to identify predi ctive indicators. RESULTS: Unilateral leg swelling/edema identified 36 of 40 (90%) patients with DVT and 8 of 10 (80%) with other thrombotic disorders (saphenous and/or chronic venous thrombosis). A history of leg pain with prior DVT or recent trauma less than or equal to 3 days' duration increased DVT duration to 98% (39 of 40). Using these criter ia, a 47% charge reduction would have been recognized. CONCLUSIONS: Im proving ED screening criteria can safely increase yield rate and reduc e charges with minimal loss of VU sensitivity. Am J Surg. 1998;176:226 -228. (C) 1998 by Excerpta Medica, Inc.