Are too many compression ultrasounds being performed for acute lower limb deep venous thrombosis in tertiary inpatients?

  • Chantele Raquel de Jager University of the Free State
  • Ruth J Moont Israel Institute of Technology
  • Nicholas E Pearce University of the Free State
Keywords: Deep Venous Thrombosis, compression ultrasounds

Abstract

Background: Venous thromboembolism (VTE) is a complex and serious condition, with high morbidity and mortality, especially in hospitalised patients. Yet its diagnosis remains challenging because of its unspecific clinical presentation. The objective of this study was to apply an algorithmic combination approach to diagnosing VTE by the addition of a D-dimer assay and Wells’ criteria for our hospital’s internal referral forms requesting compression ultrasound (CUS), to determine the effect on the number of referrals for CUS and the incidence of deep vein thrombosis (DVT) diagnoses.

Method: Inpatients who had been referred to the hospital’s vascular laboratory and who had undergone a CUS to exclude an acute lower limb DVT were retrospectively analysed between January 2009 and December 2013, and compared to prospectively collected data for the full year (2014) after the introduction of the new referral form. Comparisons included the mean annual number of referrals for CUS and the incidence of DVT diagnoses.

Results: The hospital incidence of diagnosed DVTs for 2009–2013 was 0.17%, compared to 0.16% for 2014 (p = 0.930). In contrast, the total number of referrals for CUS as a percentage of all hospital admissions dropped from 0.84% in 2009–2013 to 0.63% in 2014 (p = 0.009, odds ratio 0.76, 95% confidence interval: 0.62−0.93).

Conclusion: The implementation of Wells’ criteria and D-dimer to the new request form for CUS significantly decreased referrals to the hospital’s vascular laboratory without impacting on the number of DVT cases diagnosed. This is a positive change which simplifies care and reduces the expense of ultrasonography investigations.

Author Biographies

Chantele Raquel de Jager, University of the Free State
Faculty of Medicine
University of the Free State
Ruth J Moont, Israel Institute of Technology
PhD
The Bruce Rappaport Faculty of Medicine
Technion
Israel Institute of Technology
Haifa
Israel
Nicholas E Pearce, University of the Free State
Faculty of Medicine
University of the Free State
Published
2016-06-29
How to Cite
de Jager, C., Moont, R., & Pearce, N. (2016). Are too many compression ultrasounds being performed for acute lower limb deep venous thrombosis in tertiary inpatients?. South African Journal of Surgery, 54(2), 4-7. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/1931
Section
Vascular Surgery