Martin Angela H, Eckert George, Lemmon Gary W, Sawchuk Alan, Dalsing Michael C
Vascular Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Vascular. 2014 Apr;22(2):127-33. doi: 10.1177/1708538112474258. Epub 2013 May 13.
This study reviews the clinical and workforce impact of a suggested protocol designed for the management of suspected acute deep venous thrombosis (DVT) in patients seen after standard vascular laboratory business hours. The protocol included the use of Wells score, D-dimer and a single dose of therapeutic anticoagulant to defer venous duplex ultrasound (VDU) testing until routine business hours unless contraindicated. Information was collected on medical history, physical exam and the timing of any diagnostic studies and treatment provided. Over 15% of studies done after-hours were deemed unnecessary by our protocol and in every individual the results were negative for an acute DVT. There were no adverse events from a one-time dose of anticoagulant. Limiting emergency VDU coverage to evaluate for acute DVT based on a management protocol can eliminate unnecessary after-hours VDU testing without having a negative impact on patient care.
本研究回顾了一项建议方案对标准血管实验室工作时间之外就诊的疑似急性深静脉血栓形成（DVT）患者的临床和劳动力影响。该方案包括使用Wells评分、D-二聚体和单剂量治疗性抗凝剂，以推迟静脉超声（VDU）检查至常规工作时间，除非有禁忌证。收集了病史、体格检查以及任何诊断性检查和所提供治疗的时间等信息。根据我们的方案，超过15%的非工作时间进行的检查被认为是不必要的，且每例患者的急性DVT检查结果均为阴性。单次剂量抗凝剂未出现不良事件。基于管理方案限制用于评估急性DVT的紧急VDU检查范围，可以消除不必要的非工作时间VDU检查，且不会对患者护理产生负面影响。
