Resident performed two-point compression ultrasound is inadequate for diagnosis of deep vein thrombosis in the critically III

Caronia, Jonathan; Sarzynski, Adrian; Tofighi, Babak; Mahdavi, Ramyar; Allred, Charles; Panagopoulos, Georgia; Mina, Bushra

doi:10.1007/s11239-013-0945-5

Cited by 28 publications

(38 citation statements)

References 22 publications

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“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Of the excluded papers, five had heterogeneous study groups which included or focused on more senior clinicians, three did not objectively assess the study group post-intervention, and two did not have a practical image acquisition component to the assessments. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Of the excluded papers, five had heterogeneous study groups which included or focused on more senior clinicians, three did not objectively assess the study group post-intervention, and two did not have a practical image acquisition component to the assessments.…”

Section: Resultsmentioning

confidence: 99%

The path to ultrasound proficiency: A systematic review of ultrasound education and training programmes for junior medical practitioners

Dickson

Duncanson

Shepherd

2017

Australas J Ultrason Med

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Background: Point-of-care ultrasound (POCUS) is a form of diagnostic ultrasonography, which has a defined role as a clinical adjunct in patient assessment and management. If it is to continue to develop as a core clinical skill, junior medical practitioners and trainees may benefit from dedicated ultrasound education and familiarisation early in their training. Controversy endures, however, as inappropriate use of this highly technical and operator-dependent imaging modality has negative clinical implications. Aims: A systematic review was performed to assess the ability of doctors in training to perform clinically appropriate and beneficial diagnostic ultrasound after undergoing a formal training programme. Methods: Studies meeting pre-defined inclusion criteria were identified in electronic databases MEDLINE, EMBASE, CINAHL, PUBMED and through Google Scholar. Methodological quality was assessed using an established series of indicators. Results: Fifteen studies were included in the review. Ten of these were performed in the United States, and eight focused on emergency medicine trainees. After the teaching intervention, ten studies assessed overall ultrasound capacity by calculating the collective sensitivity and specificity of trainee-performed ultrasound. Five studies used a standardised objective assessment tool to evaluate ultrasound skills and technique. Studies varied in terms of the specific ultrasound use investigated, teaching programmes used and methodological quality. Consistently identified areas for further research included the definition of the trainee learning curve and what constitutes competency in ultrasound. Conclusions: Ultrasound can feasibly be incorporated into junior medical practitioner training, but more research is required to assess its effectiveness and appropriateness.

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Section: Resultsmentioning

confidence: 99%

The path to ultrasound proficiency: A systematic review of ultrasound education and training programmes for junior medical practitioners

Dickson

Duncanson

Shepherd

2017

Australas J Ultrason Med

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“…While some studies provided longer training, non-radiology physicians trained from 10 min to 2 h demonstrated sensitivity and specificity of nearly 100% in detecting DVT in the femoral veins in adults with point-of-care US [5, 17, 18]. In contrast to other studies, we trained our teams primarily on the image-acquisition aspects of scanning, and less on the diagnosis of DVT, because we plan to have a central adjudication of DVT in our multicenter randomized control trial [4–6].…”

Section: Discussionmentioning

confidence: 99%

“…Point-of-care US provides a rapid and accurate method of diagnosing DVT in adults in the ICU [4, 5]. Compared with consultative ultrasound or venography, point-of-care US has an average sensitivity of 96.1% and specificity of 96.8% in detecting DVT in the proximal lower extremities [6].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of point-of-care ultrasound for catheter-related thrombosis in children

Silva

Brudnicki

et al. 2015

Pediatr Radiol

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Background Compared with consultative US performed by the radiology department, point-of-care US performed by non-radiology physicians can accurately diagnose deep venous thrombosis in adults. Objective In preparation for a multicenter randomized controlled trial, we determined the accuracy of point-of-care US in diagnosing central venous catheter-related thrombosis in critically ill children. Materials and methods Children <18 years old with a central venous catheter who were admitted to the intensive care unit were enrolled. Consultative and point-of-care compression ultrasounds with Doppler were done on the vein where the catheter was inserted within 24 h after insertion. Repeat US was obtained within 24 h of removal of the catheter. All images were centrally, blindly and independently adjudicated for thrombosis by a team of pediatric radiologists. Chance-corrected agreement between readings was calculated. Results From 84 children, 152 pairs of consultative and point-of-care ultrasounds were analyzed. A total of 38 (25.0%) consultative and 17 (11.2%) point-of-care ultrasounds were positive for thrombosis. The chance-corrected agreement between consultative and point-of-care ultrasounds was 0.17 (standard error: 0.07; P=0.008). With consultative US as a reference, the sensitivity of point-of-care US was 28.1% (95% confidence interval: 13.7%–46.7%) with a specificity of 91.8% (95% confidence interval: 84.4%–96.4%). A catheter in the subclavian vein was associated with discordant readings (adjusted odds ratio: 4.00; 95% confidence interval: 1.45–13.94). Conclusion Point-of-care US, when performed by non-radiology physicians and centrally adjudicated by pediatric radiologists in the setting of a multicenter randomized controlled trial, may not accurately diagnose catheter-related thrombosis in critically ill children.

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“…All the patients who referred to Imam Reza Hospital in Mashhad, with clinical symptoms and physical findings with suspected deep vein thrombosis, during the years 2013 and 2014 were included in the study. Given the half-percent prevalence of DVT, and according to previous studies done in this area (Abbasi et al, 2012;Caronia et al, 2014;Farahmand, Farnia, Shahriaran, & Khashayar, 2011;Shiver, Lyon, Blaivas, & Adhikari, 2010) estimation of the number of the patients for study during one year was 70 patients. Patients were included in the study, based on the findings from the history and physical examination on arrival at the emergency department with suspected DVT, independent of age, gender, previous history of deep vein thrombosis, and the risk factors underlying possible.…”

Section: Methodsmentioning

confidence: 99%

Comparison of the Precision of Compression Ultrasonography and Duplex Sonography in Deep Venous Thrombosis Patients

Reihani¹,

Ahmadi²,

Rezanejad³

et al. 2016

GJHS

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Deep venous thrombosis is a prevalent disease and difficult being detected which can be lethal if developed. Ultrasonography and duplex ultrasonography are two of the diagnostic methods with their restrictions. The present study addresses the analysis of the succession of compression ultrasonography as a method with less restrictions in comparison with ultrasonography and duplex ultrasonography. The present study was conducted in the central urgency section of Imam Reza Hospital, Mashhad, Iran, which is a public academic institute, on 70 patients in 2014. All patients were subjected to compression ultrasonography before duplex ultrasonography and those who had previous duplex ultrasonography sessions with available results were excluded from the investigations. Finally, the results of 63 patients were analyzed, 7 being excluded due to their inaccessible data. According to the results, 52 percent of subjects were males and 48 percent were females. The result of the regular ultrasonography was positive for 37 and negative for 26 patients. Duplex ultrasonography, however, led to positive results for 35 patients (equivalent to 37 lower limb organs) and negative results for 28 subjects (equivalent to 41 lower limb organs). The sensitivity, specificity, and precision of the diagnosis via compression ultrasonography were found to be 97, 90, and 93.5 percent, respectively, and the positive and negative predictive values were calculated to be 90 and 97 percent, respectively, with a CI of 95 percent. The diagnostic accuracy of 96.8% suggests that the use of compression sonography can be a good accuracy in the diagnosis of deep vein thrombosis of the lower extremities, but it cannot replace more accurate methods that are currently used as available selected diagnostic methods.

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Resident performed two-point compression ultrasound is inadequate for diagnosis of deep vein thrombosis in the critically III

Cited by 28 publications

References 22 publications

The path to ultrasound proficiency: A systematic review of ultrasound education and training programmes for junior medical practitioners

The path to ultrasound proficiency: A systematic review of ultrasound education and training programmes for junior medical practitioners

Diagnostic accuracy of point-of-care ultrasound for catheter-related thrombosis in children

Comparison of the Precision of Compression Ultrasonography and Duplex Sonography in Deep Venous Thrombosis Patients

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