School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia.
Emerg Med Australas. 2013 Dec;25(6):588-96. doi: 10.1111/1742-6723.12155. Epub 2013 Nov 8.
The present study aims to quantify the sensitivity and specificity of three-point compression ultrasonography for diagnosing proximal lower extremity deep venous thrombosis when performed by Australian consultant emergency physicians with limited specific training. Secondary aims included quantifying rapidity, technical adequacy, predictability of equivocal results and relationships between emergency physician experience and proficiency.
This prospective diagnostic study enrolled a convenience sample of adult patients presenting to a major ED with suspected lower extremity deep venous thrombosis. The index test was abbreviated compression ultrasonography examining three points: common femoral, proximal great saphenous and popliteal veins. Emergency physicians received specific training. The reference test was full-leg duplex ultrasonography in the Radiology Department.
A total of 15 emergency physicians participated, enrolling 178 subjects. Sensitivity of the index test was 77.8% (95% confidence interval: 54.8-91.0%), specificity was 91.4% (95% confidence interval: 84.9%-95.3%) and accuracy was 89.6% (95% confidence interval: 83.1-94.2%). Median duration of the index test was 10 min 34 s (interquartile range: 6 min 31 s) and ED diagnosis occurred significantly before Radiology Department diagnosis. The only statistically significant relationship between emergency physician experience and proficiency related to rapidity, which increased from the 36th scan. Equivocal index tests occurred in 9.2% of examinations and emergency physicians predicted equivocal assessments with specificity of 86.1% (95% confidence interval: 78.8-91.1%).
Abbreviated ultrasonography performed by emergency physicians for proximal lower extremity deep venous thrombosis could be valuable. However, more precise estimates for sensitivity and greater understanding of relationships between emergency physician experience and proficiency are required.
本研究旨在量化接受过有限专科培训的澳大利亚顾问级急诊医师进行三点压迫式超声检查诊断下肢近端深静脉血栓形成的敏感性和特异性。次要目的包括量化其快速性、技术充分性、对不确定结果的可预测性以及急诊医师经验与熟练度之间的关系。
本前瞻性诊断研究纳入了 178 例在大型急诊部就诊疑似下肢深静脉血栓形成的成年患者。该研究采用了简化的压缩超声检查，共检查三个部位：股总静脉、大隐静脉近端和腘静脉。检查前，急诊医师接受了专门的培训。参照标准为放射科进行的下肢全长超声检查。
共有 15 名急诊医师参与，共纳入 178 例患者。该检查的敏感性为 77.8%（95%置信区间：54.8%至 91.0%），特异性为 91.4%（95%置信区间：84.9%至 95.3%），准确性为 89.6%（95%置信区间：83.1%至 94.2%）。该检查的中位数时长为 10 分 34 秒（四分位间距：6 分 31 秒），且急诊部诊断的时间明显早于放射科。急诊医师经验与熟练度之间唯一具有统计学意义的关系与快速性相关，其从第 36 次检查开始增加。9.2%的检查结果为不确定，急诊医师对不确定评估的预测特异性为 86.1%（95%置信区间：78.8%至 91.1%）。
由急诊医师进行的下肢近端深静脉血栓形成简化超声检查可能具有价值。然而，需要更精确的敏感性估计以及对急诊医师经验与熟练度之间关系的进一步理解。
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