Diagnostic Accuracy of a Three-point Compression Ultrasonography Performed by Emergency Medicine Resident for the Diagnosis of Deep Vein Thrombosis: a Prospective Diagnostic Study

Abstract

Introduction: Deep vein thrombosis (DVT) is a common cause of admission to the emergency departments (ED). Doppler ultrasonography of the entire lower limb is the first-line imaging modality. But most EDs do not access to full-time radiologists which can lead to delayed diagnosis. Aim: The aim of this study was to evaluate the diagnostic accuracy of three-point compression ultrasonography performed by emergency medicine resident for diagnosis of DVT. Methods: This prospective diagnostic study was carried out at Imam Khomeini Hospital in Sari from March 2018 to November 2018. For all patients with suspected lower extremity DVT, first bedside 3-point compression ultrasound were performed by a third year emergency medicine resident at ED. Then Doppler ultrasonography were performed by a radiologist in the radiology department, as a reference test. Sensitivity, specificity, and positive predictive value of the three-point compression ultrasound performed by emergency medicine resident was calculated. Results: Of the 72 patients enrolled in our study, 50% of the patients were male, with an average age of 36±19 years. The mean of patient admission time to perform ultrasonography by an emergency medicine resident and radiologist were 14.05±19 and 216±140.1 minutes, respectively. The two groups had a statistically significant difference (P<0.0001). In ultrasonography performed by emergency medicine resident and doper ultrasonography by radiologist, 91.67% and 36.1% of patients were diagnosed with DVT, respectively. Although the ultrasonography performed by emergency medicine resident has a relatively low sensitivity (53.8%), it has a good specificity (85.7%). The positive and negative predictive value was 70 and 75%, respectively. Conclusion: Although the results of this study indicate insufficient sensitivity of bedside three-point compression ultrasound performed by emergency medicine resident in diagnosis of lower limb DVT, the specificity, positive and negative predictive values and positive likelihood ratio were almost appropriate.

Prevalence and predictors of alternative diagnoses on whole-leg ultrasound negative for acute deep venous thrombosis

“…Some centers choose to perform a limited compression ultrasound examination as the initial test focusing primarily on the femoral and popliteal veins [5][6][7][8]. We prefer to perform a whole-leg ultrasound in all patients with suspected acute DVT in our institution, conforming to current multidisciplinary guidelines [4].…”

EFSUMB Clinical Practice Guidelines for Point-of-Care Ultrasound: Part One (Common Heart and Pulmonary Applications) LONG VERSION

“…The final research question and search strategy, PRISMA flow diagram, and results table of the final included studies are shown in tables Q6.1, Q6.2, and Q6.3, respectively. 23 references were presented 6 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 . The final summary of evidence, assignment of levels of evidence, and GRADE recommendation for this question are shown in table Q6.4.…”

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

“…Moreover, three-point compression ultrasonography showed high specificity regardless of the skill of the clinician performing the investigation. 23) Furthermore, the short amount of time that is required to perform three-point compression ultrasound reduces the risk of transmission of infection. 24) Our study has several limitations.…”