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Original Research: CRITICAL CARE |

Accuracy of Ultrasonography Performed by Critical Care Physicians for the Diagnosis of DVT

Pierre D. Kory, MD, MPA; Crescens M. Pellecchia, DO; Ariel L. Shiloh, MD; Paul H. Mayo, MD, FCCP; Christopher DiBello, MD; Seth Koenig, MD
Author and Funding Information

From the Beth Israel Medical Center (Drs Kory and Pellecchia), New York; the Montefiore Medical Center (Dr Shiloh), New York; and the North Shore-Long Island Jewish Medical Center (Drs Mayo, DiBello, and Koenig), New Hyde Park, NY.

Correspondence to: Pierre D. Kory, MD, MPA, Beth Israel Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, 7th Floor, Dazian Bldg, 16th St and 1st Ave, New York, NY 10003; e-mail: pkory@chpnet.org


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(3):538-542. doi:10.1378/chest.10-1479
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Background:  DVT is common among critically ill patients. A rapid and accurate diagnosis is essential for patient care. We assessed the accuracy and timeliness of intensivist-performed compression ultrasonography studies (IP-CUS) for proximal lower extremity DVT (PLEDVT) by comparing results with the formal vascular study (FVS) performed by ultrasonography technicians and interpreted by radiologists.

Methods:  We conducted a multicenter, retrospective review of IP-CUS examinations performed in an ICU by pulmonary and critical care fellows and attending physicians. Patients suspected of having DVT underwent IP-CUS, using a standard two-dimensional compression ultrasonography protocol for the diagnosis of PLEDVT. The IP-CUS data were collected prospectively as part of a quality-improvement initiative. The IP-CUS interpretation was recorded and timed at the end of the examination on a standardized report form. An FVS was then ordered, and the FVS result was used as the criterion standard for calculating sensitivity and specificity. Time delays between the IP-CUS and FVS were recorded.

Results:  A total of 128 IP-CUS were compared with an FVS. Eighty-one percent of the IP-CUS were performed by fellows with < 2 years of clinical ultrasonography experience. Prevalence of DVT was 20%. IP-CUS studies yielded a sensitivity of 86% and a specificity of 96% with a diagnostic accuracy of 95%. Median time delay between the ordering of FVS and the FVS result was 13.8 h.

Conclusions:  Rapid and accurate diagnosis of proximal lower extremity DVT can be achieved by intensivists performing compression ultrasonography at the bedside.


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