Analysis of an algorithm incorporating limited and whole-leg assessment of the deep venous system in symptomatic outpatients with suspected deep-vein thrombosis (PALLADIO): a prospective, multicentre, cohort study

Point-of-Care Ultrasound in the Emergency Department

“…Several studies have suggested that incorporating POCUS along with pretest probability scoring systems (e.g. Wells Score) and/or D-Dimer improves the diagnostic accuracy of POCUS [69,70,72]. Using POCUS to diagnose DVT has been shown to decrease the need for comprehensive scans, decreased timeto-diagnosis, ED length of stay, and the need for return visits [71,72].…”

Age-Adjusted D-Dimer to Rule out Deep Vein Thrombosis: Findings From the PALLADIO Algorithm

“…The Prospective Algorithm incorporating Limited and whole-Leg Assessment of the Deep venous system In symptomatic Outpatients (PALLADIO) study [15] assessed the performance of a diagnostic algorithm (combining D-dimer, PTP and limited or extended CUS) that aimed to simplify the approach to patients with suspected DVT. The combination of PTP and Ddimer indeed allowed the identification of three groups of patients: (i) patients in whom DVT could be safely ruled out without the need for CUS; (ii) patients who needed a single limited CUS, without the need for a repeated CUS after a week; and (iii) patients who needed an extended CUS, in order to assess both proximal and distal veins.…”

“…Therefore, the PALLADIO algorithm can eliminate the need for repeated serial CUS and reduce the risk of detecting isolated distal DVTs of uncertain clinical significance. The aim of this post-hoc analysis was to assess the accuracy of an age-adjusted D-dimer cut-off using the database of the PALLADIO study [15].…”

“…The PALLADIO study (ClinicalTrials.gov number: NCT01412242) was an international multicenter management study of patients with suspected DVT [15]. Briefly, inclusion criteria were consecutive adult outpatients with clinically suspected DVT of the lower extremities, referred to eight thrombosis centers in five different countries from March 2011 to July 2014 (see Appendix for the full list of contributors).…”

“…Patients with both likely PTP and positive D-dimer had a whole-leg CUS (group 3). Details regarding the ultrasonography technique have been reported in the original publication of the PALLADIO study [15].…”