MEETING ABSTRACT Open Access Point-of-care ultrasound in patients with suspected deep vein thrombosis (DVT) Mohammad Al hashimy 1* , Kim Hvid Benn Madsen 2 , Thomas Andersen Schmidt 3 From Proceedings of the 5th Danish Emergency Medicine Conference Aarhus, Denmark. 18-19 April 2013 Background Suspicion of Deep vein thrombosis (DVT) is a frequent cause of presentation in emergency departments (EDs). Traditionally at Holbaek University Hospital, patients presenting with suspected lower-extremity DVT are com- monly assessed and treated as out-patients in the Quick Diagnostic Unit (QDU), a part of our Emergency Depart- ment. The patients undergo D-dimer testing and Wells score followed by ultrasound (US) only if the D-dimer is positive, or the patient is judged clinically to have DVT (Wells score>2). Unfortunately, the limited availability of radiologist-performed ultrasound outside banker’s hours delay the diagnosis by more than 24 hours and may expose the patient to inappropriate anticoagulation treatment. The safety, ease of use, rapid time of diagnosis, low cost and accessibility makes bedside ultrasound for DVT especially useful for emergency physicians. The aim of this pilot study is to assess the time-to- diagnosis and the accuracy of emergency physician performed bedside ultrasound (EPUS) in the detecting of pathological findings (Hematoma, Baker ’ s cyst and Thrombosis), in comparison with the traditional settings involving a radiologist-performed ultrasound. Methods 10 patients with clinically suspected proximal DVT attending our QDU were included in our pilot study. All patients enrolled underwent whole-leg US performed by an emergency-physician and a radiologist. Results 10 patients were enrolled in this pilot study. The EPUS findings were normal in 7 patients (70%), abnormal in 3 patients (30%). All normal test results were confirmed by the radiologist, and 3 patients with abnormal findings on EPUS examination were subsequently diagnosed as having distal DVT or superficial thrombophlebitis. The mean time-to-diagnosis of EPUS was 2:45 h (range 00:45 to 04:12h) compared to the mean time-to- diagnosis performed by a radiologist of 27:23 h (range 04:30 h to 71:03 h), p < 0.002. The US performed by an emergency physician had a sensitivity of 100 % and specificity of 100 %. Conclusion Our findings suggest that EPPU may be useful in excluding pathological findings in patients with suspected DVT, and may allow rapid discharge and avoiding unne- cessary anticoagulant treatment. Future prospective studies are warranted to confirm these findings. This study will continue over the next few months. Authors’ details 1 Emergency Department, Holbaek Hospital , Denmark. 2 Emergency Department, Holbaek Hospital , Denmark. 3 Emergency Department, Holbaek Hospital , Denmark. Published: 9 September 2013 doi:10.1186/1757-7241-21-S2-A39 Cite this article as: Al hashimy et al.: Point-of-care ultrasound in patients with suspected deep vein thrombosis (DVT). Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013 21(Suppl 2):A39. * Correspondence: [email protected] 1 Emergency Department, Holbaek Hospital , Denmark Full list of author information is available at the end of the article Al hashimy et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013, 21(Suppl 2):A39 http://www.sjtrem.com/content/21/S2/A39 © 2013 Al hashimy et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Point-of-care ultrasound in patients with suspected deep vein thrombosis (DVT)

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Page 1: Point-of-care ultrasound in patients with suspected deep vein thrombosis (DVT)

MEETING ABSTRACT Open Access

Point-of-care ultrasound in patients withsuspected deep vein thrombosis (DVT)Mohammad Al hashimy1*, Kim Hvid Benn Madsen2, Thomas Andersen Schmidt3

From Proceedings of the 5th Danish Emergency Medicine ConferenceAarhus, Denmark. 18-19 April 2013

BackgroundSuspicion of Deep vein thrombosis (DVT) is a frequentcause of presentation in emergency departments (EDs).Traditionally at Holbaek University Hospital, patientspresenting with suspected lower-extremity DVT are com-monly assessed and treated as out-patients in the QuickDiagnostic Unit (QDU), a part of our Emergency Depart-ment. The patients undergo D-dimer testing and Wellsscore followed by ultrasound (US) only if the D-dimeris positive, or the patient is judged clinically to have DVT(Wells score>2). Unfortunately, the limited availability ofradiologist-performed ultrasound outside banker’s hoursdelay the diagnosis by more than 24 hours and mayexpose the patient to inappropriate anticoagulation treat-ment. The safety, ease of use, rapid time of diagnosis, lowcost and accessibility makes bedside ultrasound for DVTespecially useful for emergency physicians.The aim of this pilot study is to assess the time-to-

diagnosis and the accuracy of emergency physician per-formed bedside ultrasound (EPUS) in the detecting ofpathological findings (Hematoma, Baker’s cyst andThrombosis), in comparison with the traditional settingsinvolving a radiologist-performed ultrasound.

Methods10 patients with clinically suspected proximal DVTattending our QDU were included in our pilot study.All patients enrolled underwent whole-leg US performedby an emergency-physician and a radiologist.

Results10 patients were enrolled in this pilot study. The EPUSfindings were normal in 7 patients (70%), abnormal in 3patients (30%).

All normal test results were confirmed by the radiolo-gist, and 3 patients with abnormal findings on EPUSexamination were subsequently diagnosed as having distalDVT or superficial thrombophlebitis.The mean time-to-diagnosis of EPUS was 2:45 h

(range 00:45 to 04:12h) compared to the mean time-to-diagnosis performed by a radiologist of 27:23 h (range04:30 h to 71:03 h), p < 0.002.The US performed by an emergency physician had a

sensitivity of 100 % and specificity of 100 %.

ConclusionOur findings suggest that EPPU may be useful inexcluding pathological findings in patients with suspectedDVT, and may allow rapid discharge and avoiding unne-cessary anticoagulant treatment. Future prospectivestudies are warranted to confirm these findings. Thisstudy will continue over the next few months.

Authors’ details1Emergency Department, Holbaek Hospital , Denmark. 2EmergencyDepartment, Holbaek Hospital , Denmark. 3Emergency Department, HolbaekHospital , Denmark.

Published: 9 September 2013

doi:10.1186/1757-7241-21-S2-A39Cite this article as: Al hashimy et al.: Point-of-care ultrasound in patientswith suspected deep vein thrombosis (DVT). Scandinavian Journal ofTrauma, Resuscitation and Emergency Medicine 2013 21(Suppl 2):A39.

* Correspondence: [email protected] Department, Holbaek Hospital , DenmarkFull list of author information is available at the end of the article

Al hashimy et al. Scandinavian Journal of Trauma, Resuscitation andEmergency Medicine 2013, 21(Suppl 2):A39http://www.sjtrem.com/content/21/S2/A39

© 2013 Al hashimy et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.

mailto:[email protected]

http://creativecommons.org/licenses/by/2.0