Sutter Mark E, Turnipseed Samuel D, Diercks Deborah B, Samuel Peter, White Richard H
Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, California 95817, USA.
J Emerg Med. 2009 Jan;36(1):55-9. doi: 10.1016/j.jemermed.2007.08.066. Epub 2008 Mar 5.
Duplex ultrasound (US) is used to "rule out" deep venous thrombosis (DVT), but can also diagnose other causes of leg pain or swelling in Emergency Department (ED) patients. Recent literature suggests that US imaging is unnecessary among patients with low or moderate clinical probability of DVT with a normal D-dimer. We attempted to determine the incidence of clinically important incidental findings detected using venous US imaging in patients with suspected lower extremity DVT. We conducted a retrospective chart review of all ultrasounds performed by the non-invasive vascular laboratory on ED patients > 18 years old. Results were classified: normal, DVT, or incidental finding. The latter were classified as clinically significant major findings if the diagnosis led to immediate and specific treatment to prevent morbidity, or clinically significant minor findings. A total of 484 US studies were reviewed; 179 were excluded (arterial studies, penetrating trauma, upper extremity US). Findings among 305 studies were: 238 (78%) normal, 28 (9%) DVT, and 39 (12%) incidental findings. Among 39 incidental findings, 10 were clinically significant major findings and 29 clinically significant minor findings. Clinically significant major findings included: pseudoaneurysm, arterial occlusive disease, vascular graft complication, compartment syndrome, and tumor. Among 38 abnormal US studies that required immediate treatment, DVT comprised 74% (95% confidence interval 59%-85%) and important major incidental findings 26% (95% confidence interval 14%-41%). Among ED patients who underwent US to evaluate leg pain and swelling, 26% of positive studies showed clinically important findings other than DVT. Further research is needed to determine if D-dimer plus a clinical probability tool will include or exclude the patients with clinically significant major findings.
双功超声（US）用于“排除”深静脉血栓形成（DVT），但也可诊断急诊科（ED）患者腿痛或肿胀的其他原因。近期文献表明，对于DVT临床概率低或中等且D-二聚体正常的患者，US成像并无必要。我们试图确定在疑似下肢DVT患者中使用静脉US成像检测到的具有临床重要意义的偶然发现的发生率。我们对无创血管实验室为18岁以上ED患者进行的所有超声检查进行了回顾性图表审查。结果分为：正常、DVT或偶然发现。如果诊断导致采取立即且特定的治疗以预防发病，则将后者分类为具有临床意义的主要发现，或具有临床意义的次要发现。共审查了484项US研究；179项被排除（动脉研究、穿透性创伤、上肢US）。305项研究的结果为：238项（78%）正常，28项（9%）DVT，39项（12%）偶然发现。在39项偶然发现中，10项为具有临床意义的主要发现，29项为具有临床意义的次要发现。具有临床意义的主要发现包括：假性动脉瘤、动脉闭塞性疾病、血管移植物并发症、骨筋膜室综合征和肿瘤。在38项需要立即治疗的异常US研究中，DVT占74%（95%置信区间59%-85%），重要的主要偶然发现占26%（95%置信区间14%-41%）。在接受US检查以评估腿痛和肿胀的ED患者中，26%的阳性研究显示出除DVT之外具有临床重要意义的发现。需要进一步研究以确定D-二聚体加临床概率工具是否会纳入或排除具有临床意义的主要发现的患者。
