Venous Duplex Scanning for Suspected Deep Vein Thrombosis: Results Before and After Elimination of After-Hours Studies

Abstract

Objective: A 24-hour venous duplex ultrasound (VDU) for suspected deep vein thrombosis (DVT) imposes significant resource burdens on a hospital. We hypothesize that termination of after-hours services increases empiric therapy without affecting clinical outcomes. Methods: A retrospective review of patients evaluated by the emergency department (ED) for suspected DVT in 2005 and 2007. Demographics, empiric treatment, and complications were compared using propensity scores and multivariate regression models. Results: In 2005 and 2007, 318 and 365 patients, respectively, had VDU after referral by the ED. In all, 49 (16%) tests during 2005 were after-hours, with 31 and 25 acute DVTs in 2005 and 2007, respectively. More patients received empiric treatment in 2007: 51 (14%) vs 26 ([8%]; P = .019) and tended to be more likely to have acute DVT: 7 (28%) vs 3 ([10%]; P = .08). We detected no complications from empiric anticoagulation and no difference in outcome. Estimated annual savings were $11 864. Conclusions: Elimination of around-the-clock VDU can render substantial savings to hospitals without adverse consequence in the management of acute DVT.

Keywords

vascular laboratory deep vein thrombosis duplex ultrasonography

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References

Wells PS , Hirsh J. , Anderson DR , et al. Accuracy of clinical assessment of deep-vein thrombosis. Lancet. 1995;345(8973): 1326-1330.

Barnes RW , Wu KK , Hoak JC Fallibility of the clinical diagnosis of venous thrombosis. JAMA. 1975;234(6):605-607.

Lensing AW , Prandoni P. , Brandjes D. , et al. Detection of deep-vein thrombosis by real-time B-mode ultrasonography . N Eng J Med. 1989;320(6):342-345.

McCoy KL , Gahtan V. , Kerstein MD Use of venous duplex scans to evaluate symptoms of deep vein thrombosis: an analysis of ultrasound usage by various medical specialties. Am Surg. 1999; 65(5):417-420.

Langan EM 3rd , Coffey CB , Taylor SM , et al. The impact of the development of a program to reduce urgent (off-hours) venous duplex ultrasound scan studies . J Vasc Surg. 2002;36(1):132-6.

Anderson DR , Wells PS , Stiell I. , et al. Thrombosis in the emergency department: use of a clinical diagnosis model to safely avoid the need for urgent radiological investigation. Arch Inter Med. 1999;159(5):477-482.

Aboulafia ED , Lawrence L. , DeLong R. , Liebow J. Can an algorithm predict appropriate utilization of emergency venous studies? Int J Angiol. 2001;10(1):1-4.

Chaer RA , Myers J. , Pirt D. , et al. The impact of a systemwide policy for emergent off-hours venous duplex ultrasound studies. Ann Vasc Surg. 2009; 24(3):388-392.

Wells PS , Anderson DR , Bormanis J. , et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350(9094):1795-1798.

10.

Imberti D. , Ageno W. , Dentali F. , Giorgi Pierfranceschi M. , Croci E. , Garcia D. Management of primary care patients with suspected deep vein thrombosis: use of a therapeutic dose of low-molecular-weight heparin to avoid urgent ultrasonographic evaluation. J Thromb Haemost. 2006;4(5):1037-1041.

11.

Lim KE , Hsu WC , Hsu YY , Chu PH , Ng CJ Deep venous thrombosis: comparison of indirect multidetector CT venography and sonography of lower extremities in 26 patients. Clin Imaging . 2004;28(6):439-444.

12.

Bernardi E. , Camporese G. , Buller HR , et al. Serial 2-point ultrasonography plus D-dimer vs whole-leg color-coded Doppler ultrasonography for diagnosing suspected symptomatic deep vein thrombosis: a randomized controlled trial. JAMA. 2008;300(14): 1653-1659.