PURPOSE: Deep Vein thrombosis (DVT) is a common problem in the intensive care setting. Diagnosis of deep vein thrombosis is often delayed. Physician performed 2-point compression ultrasonography (CUS) for diagnosis of deep vein thrombosis has been shown to have reasonable accuracy when performed in the emergency department. We assessed the accuracy of intensivist performed 2-point CUS in the intensive care unit (ICU) for diagnosis of proximal DVT as compared to radiology performed duplex ultrasound.
METHODS: Study participants included 3 critical care fellows and 1 attending physician. Training consisted of a one hour lecture and demonstration of lower extremity CUS. The study was performed on consecutive patients admitted to the ICU who had a lower extremity ultrasound ordered for the suspicion of DVT. The CUS protocol consisted of identification and compression of the femoral and popliteal veins at a single point. The results were categorized as compressible (negative), non-compressible (positive), or indeterminate. The intensivists performing the procedure were blinded to the clinical characteristics of the patients and were not involved in the care of the patients. All patients had a venous duplex ultrasound performed and interpreted by the radiology department. Sensitivity and specificity were calculated using the radiology ultrasound as the reference standard.
RESULTS: A total of 92 studies were performed on 85 patients (5 patients had two studies and 1 had three studies). The prevalence of DVT was 15.2%. The median patient BMI was 35.1 (16-82) and the median patient fluid balance was 4.5 L. Study findings included 3 false negatives and 2 false positives for a sensitivity of 0.79 (0.57-1) and a specificity of 0.97 (0.94-1) with an overall diagnostic accuracy of 0.95(0.90-0.99). Measurement of agreement by kappa was 0.783.
CONCLUSION: With minimal training, critical care physicians can detect DVTs using 2 point CUS with a good specificity and moderate sensitivity.
CLINICAL IMPLICATIONS: A 2 point limited CUS performed by intensivists can be implemented in ICUs to help in the diagnosis of DVT.
DISCLOSURE: Casey Stahlheber, Consultant fee, speaker bureau, advisory committee, etc. Ousama Dabbagh is on the speaker bureau for Sanofi-Aventis; No Product/Research Disclosure Information