Emergency department compression ultrasound to diagnose proximal deep veinthrombosis

Emergency Department (ED) patients with suspected deep vein thrombosis (DVT ) require an objective vascular study such as ultrasound (US) to confirm th e diagnosis prior to treatment or disposition. A simple compression US test of the common femoral vein and popliteal vein reliably detects proximal DV T in symptomatic patients, Application of compression US in the ED by Emerg ency Physicians CEPs) has been tested in a single previous study. We evalua ted the ability of ED compression US, performed by EPs, to diagnose proxima l DVT as compared to duplex US performed in a vascular laboratory, A prospe ctive, observational study was conducted on a convenience sample of patient s presenting to an ED with lower extremity symptoms and signs suggestive of DVT, Patients with a history of DVT in the symptomatic extremity were excl uded. Final diagnosis of DVT was made by color-flow duplex US performed in a vascular laboratory. ED compression US was performed by one of six EP son ographers, In compression US, DVT was diagnosed by the inability to compres s the common femoral vein or popliteal vein. The examination was considered indeterminate if the veins could not be clearly identified or compressibil ity was equivocal. For statistical analysis, an indeterminate examination w as considered positive, In those cases where ED compression US was discorda nt with duplex US, and not indeterminate, we retrospectively reviewed the U S findings. There were 76 patients who completed the study, and 18 patients (24%) were diagnosed with DVT by duplex US, whom ED compression US was pos itive in 14, negative in 2, and indeterminate in 2, Among 58 patients diagn osed without DVT by duplex US, there were 4 false-positive ED compression U S examinations and 10 indeterminate examinations, In all, ED compression US was indeterminate in 12 patients (15.8%), Compared to duplex US, ED compre ssion US had a sensitivity of 88.9% (95% C.I. 65.3-98.6%) and specificity o f 75.9% (62.8-86.1), Negative predictive value was 95.7 % (85.2-99.5). Amon g ED patients with the clinical diagnosis of possible DVT, negative ED comp ression US greatly reduces the likelihood of DVT, such that discharge and o utpatient follow-up can be considered, Because of limited specificity, posi tive results require confirmation, but may justify immediate treatment pend ing follow-up testing, Indeterminate results can be expected in a significa nt number of patients and mandate further testing prior to disposition. (C) 2001 Elsevier Science Inc.