Diagnostic value of point-of-care ultrasound in deep vein thrombosis in the emergency department

J Clin Ultrasound. 2020 Nov;48(9):527-531. doi: 10.1002/jcu.22892. Epub 2020 Jul 9.

Abstract

Purpose: Point-of-care ultrasound (POCUS) has been demonstrated as one of the primary diagnostic tools for deep vein thrombosis (DVT) screening in the emergency department, but there are quite different results in the literature regarding its diagnostic value. The aim of this study is to assess the diagnostic value of POCUS in DVT diagnosis.

Methods: Patients with a clinical suspicion of DVT who underwent POCUS and were monitored by the radiology department via ultrasonography (US) or venography for DVT were retrospectively examined. POCUS examination for DVT was performed in the femoral and popliteal regions by a two-point compression technique. The inclusion criteria were age >18 years and patients with both a POCUS report and venography or US examinations performed by the radiology department (RUS) and reported by the radiology clinic. RUS and venography were considered as the gold standards.

Results: The study included 266 patients. POCUS had a sensitivity of 93% (95% CI: 84-98) and specificity of 93% (95% CI: 89-96). Its positive likelihood ratio (LR+ ) was 14 (95% CI: 8-24), and its negative likelihood ratio (LR- ) was 0.08 (95% CI: 0.03-0.19). POCUS also had a positive predictive value (PPV) of 83% (95% CI: 74-89) and a negative predictive value (NPV) of 97% (95% CI: 94-99).

Conclusions: Our study verifies that POCUS has high specificity and sensitivity for the examination of the popliteal and femoral veins by an emergency physician to evaluate patients with a preliminary diagnosis of DVT.

Keywords: POCUS; diagnostic imaging; emergency department; venous thrombosis.

MeSH terms

  • Aged
  • Emergency Service, Hospital
  • Female
  • Femoral Vein / diagnostic imaging
  • Humans
  • Lower Extremity / diagnostic imaging
  • Male
  • Middle Aged
  • Physical Examination
  • Point-of-Care Systems*
  • Retrospective Studies
  • Sensitivity and Specificity
  • Ultrasonography / methods
  • Venous Thrombosis / diagnostic imaging*