Original contribution
Real-time B-mode ultrasound in the ED saves time in the diagnosis of deep vein thrombosis (DVT)

https://doi.org/10.1016/j.ajem.2004.02.007Get rights and content

Abstract

We hypothesize that EPs can decrease the time to disposition when performing examinations for deep venous thrombosis (DVT) compared with disposition times using imaging specialists (IS). We performed a prospective, single-blind observational study at an academic ED over the course of 1 year. Patients were enrolled based on study physician availability. EPs ordered the corroborative ultrasound, then performed their own examination. EPs recorded patient triage time, ED results, and disposition times for both EP and IS departments. One hundred fifty-six patients were enrolled. Thirty-four (22%) were diagnosed with a DVT. Mean time from triage to EP disposition was 95 minutes and mean time from triage to radiology disposition was 220 minutes. The difference of 125 minutes was statistically significant (P <.0001). EPs and ISs had excellent agreement (kappa = 0.9). Compression ultrasound performed by EPs resulted in a significant decreased time to disposition. Agreement with ISs was excellent.

Section snippets

Study design

This was a single-blind, prospective, observational study of patients who presented to our ED with complaints or physical findings suggestive of LE DVT. The study used a convenience sample of patients. All patients gave consent before the ED ultrasound. The study was approved by the Institutional Review Board.

Study setting and population

Study subjects were enrolled over a 1-year period at a suburban tertiary care ED with a census of 70,000 patients per year. All patients who presented to the ED with symptoms suggestive of

Conclusions

Our study indicates that EPs can decrease the time to disposition decision when performing their own ultrasound examinations of the lower extremities to rule out DVT rather than relying on radiology performed studies.

References (28)

  • M Blaivas et al.

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

    Acad Emerg Med

    (2000)
  • B.T Jolly et al.

    Color Doppler ultrasonography by emergency physicians for the diagnosis of acute deep venous thrombosis

    Acad Emerg Med

    (1997)
  • A Cogo et al.

    Distribution of thrombosis in patients with symptomatic deep vein thrombosis. Implications for simplifying the diagnostic process with compression ultrasound

    Arch Intern Med

    (1993)
  • J.A Pezzullo et al.

    Symptomatic deep vein thrombosisdiagnosis with limited compression

    US Radiology

    (1996)
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