Interobserver Agreement of Complete Compression Ultrasound for Clinically Suspected Deep Vein Thrombosis

Abstract

The interobserver variability of compression ultrasound of proximal and distal veins in clinically suspected deep vein thrombosis was assessed. One hundred one symptomatic legs of all patients referred for clinically suspected deep vein thrombosis on 21 consecutive workdays were examined by two investigators independently according to a standardized protocol of complete compression ultrasound (CCUS) with 28 predefined venous segments between groin and ankle. Incompressible vein segments were defined as thrombotic. Cohen's kappa coefficient was used to calculate interobserver variability regarding diagnosis of deep vein thrombosis. Kappa for entire lower extremity was 0.94 (95% CI, 0.87-1). Kappa for proximal veins was 1; for calf veins 0.9 (95% CI, 0.79-1). For the posterior tibial veins and peroneal veins, kappa was 0.84 (95% CI, 0.66-1) and 0.77 (95% CI, 0.59-0.94), respectively. The results show that almost complete interobserver agreement can be achieved in compression ultrasound of both proximal and distal deep veins conducted according to a standardized examination protocol in clinically suspected deep vein thrombosis.

Treatment of Proximal Deep-Vein Thrombosis With the Oral Direct Factor Xa Inhibitor Rivaroxaban (BAY 59-7939)

“…CCUS is accurate in patients with symptomatic DVT. 25 Thus, for the purposes of the present study, we converted the validated venographic surrogate measure to ultrasound using a standardized examination protocol (CCUS) that was validated internally 18 and externally 26 in previous studies. We also designed a scoring system that closely resembled the venographic Marder score.…”

“…In a previous study, high interobserver agreement existed in identifying affected proximal and distal venous segments in symptomatic patients (ϭ1.0 and ϭ0.90, respectively) with this CCUS protocol. 18 The score for each affected venous segment (except for the deep femoral) was adjusted for thrombus diameter (assessed under full compression and compared with the diameter of the corresponding artery). The segment score was increased 1.5-fold if its compressed diameter was Ն1.5 times the arterial diameter and reduced 0.5-fold if this was Յ0.5 times the arterial diameter.…”

Efficacy and safety of venous thromboembolism prophylaxis with fondaparinux or low molecular weight heparin in a large cohort of consecutive patients undergoing major orthopaedic surgery – findings from the ORTHO‐TEP registry

“…According to our hospital guidelines, all patients with clinical suspicion of DVT underwent immediate (within 24 h) bilateral complete compression ultrasound (CCUS) in our vascular unit by vascular specialists experienced in compression ultrasound using a standardized CCUS protocol [19,20]. Proximal DVT was defined as any DVT occurring in a vein of the deep vein system of the lower extremity at the level of the popliteal vein or above.…”

Deep vein thrombosis and bilateral pulmonary embolism following minor trauma to the popliteal fossa: could this have been avoided?

“…In terms of the discrepancy between the two US reports, this could have been due to interrater reliability; however, it has been shown that with experienced observers, interobserver reliability for lower extremity DVT is excellent, at 94%. 12 It is unclear why the second sonogram was negative; however, it does not change the fact that there was a previous positive sonogram. This patient had a posttest probability of DVT greater than 90% after the initial positive sonogram, suggesting that he should have been maintained on the appropriate dose and duration of anticoagulant therapy.…”