SonoStudy: Emergency Physician-Performed Ultrasound for DVT – a systematic review and meta-analysis

A recent study has made me so excited that I hope it has the Nay-sayers out there ponder and become believers!

“Duplex ultrasound is the first-line diagnostic test for detecting lower limb deep-vein thrombosis (DVT) but it is time consuming, requires patient transport, and cannot be interpreted by most physicians. The accuracy of emergency physician-performed ultrasound (EPPU) for the diagnosis of DVT, when performed at the bedside, is unclear. We did a systematic review and meta-analysis of the literature, aiming to provide reliable data on the accuracy of EPPU in the diagnosis of DVT. The MEDLINE and EMBASE databases (up to August 2012) were systematically searched for studies evaluating the accuracy of EPPU compared to either colour-flow duplex ultrasound performed by a radiology department or vascular laboratory, or to angiography, in the diagnosis of DVT. Weighted mean sensitivity and specificity and associated 95% confidence intervals (CIs) were calculated using a bivariate random-effects regression approach. There were 16 studies included, with 2,379 patients. The pooled prevalence of DVT was 23.1% (498 in 2,379 patients), ranging from 7.4% to 47.3%.

Using the bivariate approach, the weighted mean sensitivity of EPPU compared to the reference imaging test was 96.1% (95%CI 90.6-98.5%), and with a weighted mean specificity of 96.8% (95%CI:94.6-98.1%). Our findings suggest that EPPU may be useful in the management of patients with suspected DVT. Future prospective studies are warranted to confirm these findings.”

That’s right, you read it correctly – EPPU is ok to do and can be useful in the evaluation for DVT – but, of course, it takes studies for people to believe us. Using the two-point compression technique at 2 sites: femoral and popliteal  - identify the vein (its the one next to the artery), compress the vein at 1 cm intervals for at least 5 cm length. A noncompressible vein is positive for DVT. Echogenicity, augmentation are proven to not increase your findings of a DVT, and therefore are not needed. Simply compress.

Here is a great 5 minute review of the DVT Ultrasound technique by SonoSite:

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