Physician Performed Two-point Compression Ultrasound Is An Effective Assessment Tool For Diagnosis Of Deep Vein Thrombosis In The Trauma Intensive Care Unit
Joel B. Durinka, M.D., Brandon Kuehlewind, MD, Goda Savulionyte, MD, Linda Harris, MD, Raphael Blochle, MD, Sikandar Khan, MD, James K. Lukan, MD.
University of Buffalo, Buffalo, NY, USA.
Objectives: Venous thromboembolism includes deep vein thrombosis and pulmonary embolism and is known to be associated with significant morbidity and mortality following complex surgery and trauma. Duplex ultrasonography performed by vascular sonographers and interpreted by credentialed physicians has been accepted as the gold standard for diagnosis of DVT for many years. Prior studies have considered the efficacy of using this modality as a screening tool in the critical care setting, and while effective, logistics and cost precluded widespread adoption.As an alternative, there is evidence that a modified ultrasound examination can be safely and accurately performed by clinicians at the bedside. The objective of this study was to measure the operating characteristics of providers performing a two-point compression test for evaluation of DVT.Methods: This is a prospective cohort study enrolling a convenience sample of patients. Surgical residents performed two-point bedside compression for DVT and the results were compared with venous duplex studies interpreted by credentialed vascular surgeons. The cohort of this study consisted of hospitalized patients in the Trauma Intensive Care Unit (TICU) at a level 1 trauma center. The primary outcomes were the sensitivity, specificity, and predictive values of the two-point compression ultrasound compared with formal venous duplex. Secondary outcomes included time to complete the studies and prevalence of undiagnosed DVT in a Level 1 TICU.Results: Fifty-eight limbs from 29 patients were scanned. The prevalence of DVT was 5.2% (3/58). The sensitivity of three-point ultrasound for DVT was 100% (95% CI 29.2-100%) and specificity was 100% (95% CI 94-100%) with a positive predictive value of 100% (95% CI 35-84%) a negative predictive value of 100%, and an accuracy of 100% (95% CI 93.8-100%). The average time to perform the test at bedside was 9.3 minutes (Range 5-30 minutes)Conclusion: Major acute DVT is unlikely to be missed using this screening technique. Providers without formal sonographic training can perform compression-only ultrasound in a TICU with an accuracy similar to other specialties and settings. Results are available more quickly than a formal venous duplex. Integration of compression ultrasonography into the daily exam results in the diagnosis of unsuspected and potentially clinically important DVTs without a significant increase in work for the provider. Further study is required to determine how to best incorporate bedside ultrasound result into clinical practice.
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