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The Utility of Lower Extremity Duplex to Diagnose DVT in Patients with Lower Extremity Swelling and Pain
Khanjan H. Nagarsheth, MD, George Benson, MD, Phyllis Suen, Saqib Zia, MD, Jonathan Schor, MD, Kuldeep Singh, MD, Jonathan S. Deitch, MD.
Staten Island University Hospital, Staten Island, NY, USA.
Objective:
Lower extremity venous duplex ultrasound (LEVDU) is over-utilized to exclude deep vein thrombosis (DVT) in patients with leg pain and swelling. These findings alone are not enough to warrant DVT screening with lower extremity venous duplex ultrasound (LEVDU). We performed this study to evaluate the utility of LEVDU in identifying DVT in patients presenting with lower extremity pain and swelling.
Methods:
We performed a retrospective review and chart analysis for all LEVDU performed at our institution from May 2013 until July 2013. We identified studies that were performed for an indication of lower extremity swelling, pitting edema or extremity pain (ICD-9: 729.81, 782.3 and 729.5, respectively). A comprehensive chart review was performed for each patient looking at variables including; gender, race, smoking history, history of prior DVT, newly diagnosed cancer, BMI, limb swelling, presence of pitting edema and localized extremity pain. Multivariate analysis was conducted using SPSS 20. Nonparametric data was analyzed using Chi square test and parametric data was compared using independent sample t-test. The level of significance was set to an alpha of 0.05.
Results:
A total of 1,442 LEVDU were performed during this time period of these only 119 (8.3%) were positive for lower extremity DVT. There were 807 LEVDU ordered for ICD-9 codes 729.81, 782.3 and 729.5 (232, 275 and 300, respectively). Ninety-one of these patients (11.2%) were positive for DVT.
Patients positive for DVT were more likely to have a history of prior DVT (p<0.001), recently diagnosed cancer (p<0.001) and paralysis (p<0.001) compared to those who were negative.
The negative group had a significantly higher incidence of whole limb swelling (p<0.001), pitting edema (p<0.001) and localized pain (p<0.001) compared to the positive group. This group was also significantly older (p<0.001) and had a higher BMI (p<0.001) than the DVT group.
Conclusions:
Based on this analysis, physical exam findings of lower extremity swelling, pain and pitting edema may not necessarily be indicative of DVT, and a thorough differential diagnosis should be explored before ordering a LEVDU. This may help to reduce hospital cost and labor.
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