Effectiveness of an algorithm in reducing the number of unnecessary ultrasound scans for deep vein thrombosis: an evaluation report.
Singapore Med J
; 53(9): 595-8, 2012 Sep.
Article
en En
| MEDLINE
| ID: mdl-23023901
INTRODUCTION: Patients with suspected deep vein thrombosis (DVT) pose a diagnostic dilemma to the Emergency Department (ED) clinician. This study aimed to implement a known algorithm incorporating the modified Wells criteria and D-dimer testing to guide the ED clinician, thus reducing unnecessary ultrasound scans (USS). METHODS: Patients who presented to the ED between August 2008 and April 2009 with suspected DVT underwent Wells scoring. Those with scores < 2 were deemed unlikely to have DVT and underwent D-dimer testing first. Patients with scores ≥ 2 were regarded as likely to have DVT and underwent urgent USS. USS findings were tabulated as positive or negative/indeterminate for DVT. The latter group was followed up for one year to check whether DVT was missed during the initial USS. RESULTS: 75 patients presented with suspected DVT and underwent USS. Of these, 14 results were positive and 61 were negative. 37 patients had Wells scores < 2, with three (8.1%) having DVT. Another 38 patients had Wells scores ≥ 2, with 11 (28.9%) having DVT. D-dimer testing was performed on 27 of the 75 patients. Those with DVT had higher average values compared to those without DVT (1.305 vs. 0.595 µg/ml). The majority of patients with raised D-dimer values had cellulitis, although three also had DVT (with values ≥ 0.99 µg/ml). CONCLUSION: We managed to reduce the number of unnecessary USS and increase the pick-up rate of DVT. A cut-off score ≥ 2 in our algorithm is suitable for use in the ED setting.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Productos de Degradación de Fibrina-Fibrinógeno
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Indicadores de Salud
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Procedimientos Innecesarios
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Trombosis de la Vena
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
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Prognostic_studies
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Risk_factors_studies
Aspecto:
Determinantes_sociais_saude
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Patient_preference
Límite:
Adolescent
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Adult
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Aged
/
Aged80
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Female
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Humans
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Male
/
Middle aged
País/Región como asunto:
Asia
Idioma:
En
Revista:
Singapore Med J
Año:
2012
Tipo del documento:
Article
País de afiliación:
Singapur
Pais de publicación:
India