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

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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.

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Acknowledgments

This work was supported by an educational grant from the New York State Department of Health, ECRIP, Empire Clinical Research Investigator Program.

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No authors have any other relevant conflicts of interest.

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, 100 E 77th Street, New York, NY, 10075, USA

    Jonathan Caronia, Adrian Sarzynski, Babak Tofighi, Ramyar Mahdavi, Charles Allred & Bushra Mina

  2. Department of Bio-statistics, Lenox Hill Hospital, 100 E 77th Street, New York, NY, 10075, USA

    Georgia Panagopoulos

Authors
  1. Jonathan Caronia
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  2. Adrian Sarzynski
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  3. Babak Tofighi
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  4. Ramyar Mahdavi
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  6. Georgia Panagopoulos
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  7. Bushra Mina
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Correspondence to Jonathan Caronia.

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Caronia, J., Sarzynski, A., Tofighi, B. et al. Resident performed two-point compression ultrasound is inadequate for diagnosis of deep vein thrombosis in the critically III. J Thromb Thrombolysis 37, 298–302 (2014). https://doi.org/10.1007/s11239-013-0945-5

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