Lower-extremity Doppler for deep venous thrombosis - Can emergency physicians be accurate and fast?

Clinical diagnosis of lower-extremity(LE) deep venous thrombosis (DVT) requ ires confirmation by an imaging study before committing the patient to anti coagulation therapy. Studies have shown that demonstrating compressibility of leg veins under ultrasound is accurate for ruling out DVTs when performe d by vascular specialists. Although LE Doppler has become the preferred tes t for diagnosing DVTs, it is not always available 24 hours per day. Objecti ves: To evaluate the accuracy and speed with which emergency physicians (EP s) could perform LE color duplex ultrasonography for the detection of DVT. Methods: Patients presenting to an urban community emergency department (ED ) between August 1, 1998, and March 3, 1999, were enrolled into this prospe ctive study. The EPs, who underwent brief and standardized training, scanne d patients at high risk for DVT with leg pain, swelling, or both. Physician s performed color duplex ultrasound examinations with compression at the co mmon femoral and popliteal veins. The time until completion of the ED scan was recorded with a standardized method. The vascular laboratory performed a complete duplex ultrasound examination within eight hours. Results: One h undred twelve patients were enrolled in the study, with 34 positive for DVT . The median examination time was 3 minutes 28 seconds (95% CI = 2 min 45 s ec to 4 min 2 sec; IQR 3 min 9 sec). Times ranged from 1:02 to 18:20 minute s. The ED results had a high correlation with vascular laboratory studies, giving a kappa of 0.9 and a 98% agreement (95% CI = 95.4% to 100%). Conclus ion: Emergency physicians can perform LE duplex ultrasound examinations acc urately and quickly.