Journal of Thrombosis and Thrombolysis

, Volume 37, Issue 3, pp 298–302

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

  • Jonathan Caronia
  • Adrian Sarzynski
  • Babak Tofighi
  • Ramyar Mahdavi
  • Charles Allred
  • Georgia Panagopoulos
  • Bushra Mina
Article

DOI: 10.1007/s11239-013-0945-5

Cite this article as:
Caronia, J., Sarzynski, A., Tofighi, B. et al. J Thromb Thrombolysis (2014) 37: 298. doi:10.1007/s11239-013-0945-5

Abstract

Doppler ultrasonography is a standard in diagnosis of deep vein thrombosis (DVT) but is often delayed. Clinician-performed focused vascular sonography (FVS) has proven to accurately diagnose DVT in the ambulatory and emergency room settings. Whether trained medical residents can perform quality FVS in the critically ill is unknown. Medical residents were trained in a 2-hour module in FVS assessing for complete compressibility of common femoral and popliteal veins. Residents imaged consecutive medical ICU and intermediate care patients awaiting comprehensive, sonographer-performed and radiologist-interpreted examinations. Sensitivity, specificity, positive and negative predictive values of the focused examination were calculated against the comprehensive study. Fleiss Kappa (κ), the degree of agreement between resident and radiologist, was calculated. Time savings was measured. Nineteen residents performed 143 studies on 75 patients. Twelve patients had above-the-knee DVTs, a prevalence of 16 %. All 6 common femoral and 7 of 9 popliteal vein DVTs were identified. None of 6 isolated superficial femoral DVTs were identified. Sensitivity for above-the-knee DVT was 63 %, specificity 97 %. Sensitivity for common femoral and popliteal DVT was 86 %, specificity 97 %. Residents showed substantial agreement with radiologists for diagnosis of DVT (κ = 0.70, SE 0.114, p < 0.001).Time from order of a formal ultrasound to a radiologist’s read averaged 14.7 h. The two-point compression ultrasound method demonstrated insufficient sensitivity in a cohort of critically ill medical patients due to a high-incidence of superficial femoral DVT. However, residents demonstrated substantial agreement with radiologists for the diagnosis of clinically relevant DVT after a 2-hour course. FVS should include the superficial femoral vein and is associated with a significant time savings.

Keywords

Focused vascular sonography Residents Imaging 

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jonathan Caronia
    • 1
  • Adrian Sarzynski
    • 1
  • Babak Tofighi
    • 1
  • Ramyar Mahdavi
    • 1
  • Charles Allred
    • 1
  • Georgia Panagopoulos
    • 2
  • Bushra Mina
    • 1
  1. 1.Division of Pulmonary and Critical Care MedicineLenox Hill HospitalNew YorkUSA
  2. 2.Department of Bio-statisticsLenox Hill HospitalNew YorkUSA

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