Comparison of the Accuracy of Emergency Department-Performed Point-of-Care-Ultrasound (POCUS) in the Diagnosis of Lower-Extremity Deep Vein Thrombosis

García, Jorge Pedraza; Alonso, Joaquín Valle; García, Pedro Ceballos; Rodríguez, Francisca Rico; López, Miguel Ángel Aguayo; Muñoz-Villanueva, María del Carmen

doi:10.1016/j.jemermed.2017.12.020

Cited by 52 publications

(31 citation statements)

References 12 publications

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“…One of them [38] evaluated the diagnostic performance of 2-point and 3-point POCUS using different 2 cohorts (2 diagnostic performance studies in 1 article); thus, we evaluated 17 studies from the final 16 original research articles. Among them, 9 studies [8–10,29,30,33,34,37,38] evaluated the performance of the 2-point POCUS for diagnosing DVT, and 8 studies [11,12,28,31,32,35,36,38] evaluated the performance of the 3-point POCUS for diagnosing DVT.…”

Section: Resultsmentioning

confidence: 99%

Comparison of 2-point and 3-point point-of-care ultrasound techniques for deep vein thrombosis at the emergency department

Lee

Yun

2019

Medicine

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Background: To our knowledge, so far, no studies have comprehensively examined the performance of 2-point and 3-point point-of-care compression ultrasound (POCUS) in the diagnosis of lower extremity deep vein thrombosis (DVT). The aim of this meta-analysis was to compare the performance of 2-point and 3-point POCUS techniques for the diagnosis of DVT and evaluate the false-negative rate of each POCUS method. Methods: A computerized search of the PubMed, EMBASE, and Cochrane library databases was performed to identify relevant original articles. Bivariate modeling and hierarchical summary receiver operating characteristic modeling were performed to compare the diagnostic performance of 2-point and 3-point POCUS. The pooled proportions of the false-negative rate for each POCUS method were assessed using a DerSimonian–Laird random-effects model. Meta-regression analyses were performed according to the patient and study characteristics. Results: Seventeen studies from 16 original articles were included (2-point, 1337 patients in 9 studies; 3-point, 1035 patients in 8 studies). Overall, 2-point POCUS had similar pooled sensitivity [0.91; 95% confidence interval (95% CI), 0.68–0.98; P = .86) and specificity (0.98; 95% CI, 0.96–0.99; P = .60) as 3-point POCUS (sensitivity, 0.90; 95% CI, 0.83–0.95 and specificity, 0.95; 95% CI, 0.83–0.99). The false-negative rates of 2-point (4.0%) and 3-point POCUS (4.1%) were almost similar. Meta-regression analysis showed that high sensitivity and specificity tended to be associated with an initial POCUS performer (including attending emergency physician > only resident) and separate POCUS training for DVT (trained > not reported), respectively. Conclusion: Both 2-point and 3-point POCUS techniques showed excellent performance for the diagnosis of DVT. We recommend that POCUS-trained attending emergency physicians perform the initial 2-point POCUS to effectively and accurately diagnose DVT.

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Section: Resultsmentioning

confidence: 99%

Comparison of 2-point and 3-point point-of-care ultrasound techniques for deep vein thrombosis at the emergency department

Lee

Yun

2019

Medicine

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“… 23 ) Furthermore, the short amount of time that is required to perform three-point compression ultrasound reduces the risk of transmission of infection. 24 )…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Need for Early Initiation of Rehabilitation Treatments in Patients with Coronavirus Disease 2019

Suzuki

Sakai

Hoshino

et al. 2020

PRM

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Objective: The aim of this study was to describe the clinical characteristics of coronavirus disease (COVID-19) patients, including risk factors for deep vein thrombosis and pulmonary embolism, and to evaluate the need for rehabilitation to prevent pulmonary embolism. Methods: A retrospective medical record review was conducted of patients admitted to the study hospital with COVID-19 between April 2 and April 23, 2020. The clinical characteristics and blood test results of patients with no history on admission of oral anticoagulant use were evaluated to assess the importance of inflammation and clotting function as risk factors for pulmonary embolism. Results: A total of 51 patients with COVID-19 were admitted during the study period. Their median age was 54.0 years (range: 41–63 years) and 38 of 51 (74.5%) were men. The most common comorbidities in men were diabetes (9/38, 23.7%) and hypertension (13/38, 34.2%). On admission, white blood cell counts were normal in both sexes, whereas C-reactive protein and hemostatic marker levels, except for the activated partial thromboplastin time, were significantly higher in men. Moreover, C-reactive protein and hemostatic marker levels were significantly higher in patients that required invasive ventilation. Two patients were diagnosed with acute pulmonary embolism, neither of whom required invasive ventilation. Conclusions: Hypercoagulability and hyperinflammation were observed in COVID-19 patients, especially in men with high oxygen demand. We recommend anticoagulant therapy and early rehabilitation intervention to prevent pulmonary embolism in COVID-19 patients.

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“…Since US is naturally user‐dependent, training of emergency physicians and regular clinical use of US in the ED are mandatory for increasing the sensitivity and specificity of US as a diagnostic tool 8 . Routine use of POCUS for emergency physicians to receive regular POCUS training and DVT screening in the ED will ensure the recognition of DVT early and accurately.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of point‐of‐care ultrasound in deep vein thrombosis in the emergency department

Çanakçı

Acar

Bilgin

et al. 2020

J of Clinical Ultrasound

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Point-of-care ultrasound (POCUS) has been demonstrated as one of the primary diagnostic tools for deep vein thrombosis (DVT) screening in the emergency department, but there are quite different results in the literature regarding its diagnostic value. The aim of this study is to assess the diagnostic value of POCUS in DVT diagnosis. Methods: Patients with a clinical suspicion of DVT who underwent POCUS and were monitored by the radiology department via ultrasonography (US) or venography for DVT were retrospectively examined. POCUS examination for DVT was performed in the femoral and popliteal regions by a two-point compression technique. The inclusion criteria were age >18 years and patients with both a POCUS report and venography or US examinations performed by the radiology department (RUS) and reported by the radiology clinic. RUS and venography were considered as the gold standards. Results: The study included 266 patients. POCUS had a sensitivity of 93% (95% CI: 84-98) and specificity of 93% (95% CI: 89-96). Its positive likelihood ratio (LR +) was 14 (95% CI: 8-24), and its negative likelihood ratio (LR −) was 0.08 (95% CI: 0.03-0.19). POCUS also had a positive predictive value (PPV) of 83% (95% CI: 74-89) and a negative predictive value (NPV) of 97% (95% CI: 94-99). Conclusions: Our study verifies that POCUS has high specificity and sensitivity for the examination of the popliteal and femoral veins by an emergency physician to evaluate patients with a preliminary diagnosis of DVT.

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Comparison of the Accuracy of Emergency Department-Performed Point-of-Care-Ultrasound (POCUS) in the Diagnosis of Lower-Extremity Deep Vein Thrombosis

Cited by 52 publications

References 12 publications

Comparison of 2-point and 3-point point-of-care ultrasound techniques for deep vein thrombosis at the emergency department

Comparison of 2-point and 3-point point-of-care ultrasound techniques for deep vein thrombosis at the emergency department

Assessment of the Need for Early Initiation of Rehabilitation Treatments in Patients with Coronavirus Disease 2019

Diagnostic value of point‐of‐care ultrasound in deep vein thrombosis in the emergency department

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