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OBJECTIVES:
Emergency department POCUS can identify LEVT with a published accuracy is 85 - 90 %. The aims of this study was to compare the patterns of LEVT with protocol results and determine the clinical impact of the study results.
METHODS:
Patterns of superficial (SVT) and deep (DVT) venous thrombosis were collated from positive venous duplex ultrasound (VDU) studies. Each pattern was mapped to the potential findings by the described POCUS protocols. Analysis of the literature was used to identify the potential clinical impact of the findings and the functional efficacy of each strategy and a numerical result was developed.
RESULTS:
106 studies were positive for DVT (42), SVT (44) or both (20) on VDU. Patterns for DVT (single or multiple levels and unilateral or bilateral) and SVT (great saphenous vein above and/or below knee or small saphenous vein in single, multiple or bilateral and juxta-junctional) were noted. The patterns covered by the ‘two area’ protocol showed DVT = 80%, SVT = 38% and by ‘3 point compression’ DVT = 74%, SVT = 0%. Particular areas not covered included proximal disease (iliac and vena cava) and calf DVT and SVT in all areas except juxta-junctional. The potential impact for DVT is high, whereas, SVT is moderate to low. The functional efficacy of the ‘two area’ protocol (5.9) exceeds the ‘three point compression’ strategy (3.7) but falls short of the ‘gold standard’ VDU.
CONCLUSIONS:
Pattern analysis of venous thrombosis identifies weakness in POCUS strategies; the clinical implications allow for an assignment of the functional efficacy of each study. Knowledge of these findings should inform emergency room POCUS strategies.