Abstract
Background
Compression ultrasonography is the most effective diagnostic tool in the emergency
department (ED) for the diagnosis of deep vein thrombosis (DVT). It has been demonstrated
to be highly accurate and cost-effective.
Objective
The objective of this study was to determine the accuracy of emergency physicians
who performed three-point compression ultrasound (US) for suspected above-knee DVT
within the context of using Wells score and D-dimer.
Method
This was a prospective diagnostic test assessment of three-point ultrasound conducted
in a district general hospital of patients who presented to the ED with suspected
DVT of the lower limb. The accuracy of three-point ultrasound carried out by the emergency
physicians was assessed by comparison of the Doppler ultrasound carried out by the
Radiology Department as reference standard. The study incorporated ultrasound alongside
the Wells score and D-dimer.
Results
A total of 109 patients (66.1%) had a three-point compression point-of-care ultrasound
in the ED and a second ultrasound performed by the Radiology Department. Bedside three-point
compression ultrasound of the lower extremity performed by physicians in the ED had
a sensitivity of 93.2% (95% confidence interval [CI] 83.8–97.3%) and a specificity
of 90.0% (95% CI 78.6–95.7%), with an accuracy of 91.7% (95% CI 85–95.6%).
Conclusions
Emergency physicians can obtain a level of competence equivalent to that of radiologists,
but it requires substantial training and practice to achieve and maintain this performance.
Providers should be aware of their limitations and maintain regular training with
ultrasound applications.
Keywords
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Article info
Publication history
Published online: January 03, 2018
Accepted:
December 1,
2017
Received in revised form:
November 7,
2017
Received:
September 19,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Comparison of the Accuracy of Emergency Department–Performed Point-of-Care Ultrasound in the Diagnosis of Lower-Extremity Deep Vein ThrombosisJournal of Emergency MedicineVol. 55Issue 5
