Compression Ultrasonography of the Lower Extremity With Portable Vascular Ultrasonography Can Accurately Detect Deep Venous Thrombosis in the Emergency Department Ann Emerg Med. 2010;56:601-610

[I’m still reading the EM literature fairly avidly, i’m just not posting quite as much as I did]

I’m a bit of an ED USS fan. For the simple things. Keep it simple and we’ll not cock it up. I promise.

Some in the radiology are (understandably) concerned about letting us play around with the higher frequencies. I agree, lots of these concerns are genuine but some are just nervous titters over who own which turf.

Every other specialty in the hospital seems to get free (mainly unaccredited) reign with the USS machine. In EM there’s a lot of work going into this so it’s kind of an inevitability that we’ll be waving an USS probe at you in the near future.

Anyhow

DVTs are dull and largely uninteresting. But some of them are probably important. Not nearly as many as we think mind you, but definitely some of them. There is a movement towards abandoning imaging anything below the knee for DVT. If you look you’ll find them, it just seems that they don’t mean anything.

The radiology dept. in our place seem to be mainly doing this.

This study sought to prove that we can do this (very simple, come on admit it…) imaging study as well as the radiology techs can do it with very little training.

This place had 60000 patients a year and 60 docs (of note we see 78000 a year and have about 25!) of whom 45 docs did the enrolling. Most were middle-grades with some (but not much DVT) USS experience.

The enrolled everyone who they had enough concern to  order an USS in the radiology dept.

They did a 2-point compression exam (femoral and popliteal only) and compared this with the radiology exam (proximal limb only but not a 2-point compression).

And they got the same results (about 25% were positive overall) as the radiology dept did.

[They actually did better as the ED called one scan +ve that the radiology called -ve yet it turned +ve when they repeated it a week later!]

I think this is pretty compelling stuff. If we can finally grow the balls to stop worrying about below knee DVTs (unless there’s some other reason to worry about them) and get some basic, universal USS training and culture going in the ED (which the college are pushing for pretty well, even if Northern Ireland isn’t quite on the ball yet) then we can make this whole thing a lot less hassle for both us and our patients.

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