Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA.
Department of Medicine, University of Cincinnati, Cincinnati, OH, USA.
J Gen Intern Med. 2019 Oct;34(10):2062-2067. doi: 10.1007/s11606-019-05120-5. Epub 2019 Aug 6.
Venous thromboembolism includes deep vein thrombosis (DVT) and pulmonary embolism. Compression ultrasonography is the most common way to evaluate DVT and is typically performed by sonographers and interpreted by radiologists. Yet there is evidence that ultrasound examinations can be safely and accurately performed by clinicians at the bedside.
To measure the operating characteristics of hospital medicine providers performing point-of-care ultrasound (POCUS) for evaluation of DVT.
This is a prospective cohort study enrolling a convenience sample of patients. Hospital medicine providers performed POCUS for DVT and the results were compared with the corresponding formal vascular study (FVS) interpreted by radiologists.
Hospitalized non-ICU patients at four tertiary care hospitals for whom a DVT ultrasound was ordered.
The primary outcomes were the sensitivity, specificity, and predictive values of the POCUS compression ultrasound compared with a FVS. The secondary outcome was the elapsed time between order and the POCUS study compared with the time the FVS was ordered to when the formal radiology report was finalized.
One hundred twenty-five limbs from 73 patients were scanned. The prevalence of DVT was 6.4% (8/125). The sensitivity of POCUS for DVT was 100% (95% CI 74-100%) and specificity was 95.8% (95% CI 91-98%) with a positive predictive value of 61.5% (95% CI 35-84%) and a negative predictive value of 100% (95% CI 98-100%). The median time from order to POCUS completion was 5.8 h versus 11.5 h median time from order until the radiology report was finalized (p = 0.001).
Hospital medicine providers can perform compression-only POCUS for DVT on inpatients with accuracy similar to other specialties and settings, with results available sooner than radiology. The observed prevalence of DVT was lower than expected. POCUS may be reliable in excluding DVT but further study is required to determine how to incorporate a positive POCUS DVT result into clinical practice.
静脉血栓栓塞症包括深静脉血栓形成（DVT）和肺栓塞。压缩超声检查是评估 DVT 的最常用方法，通常由超声医师进行，并由放射科医师进行解读。然而，有证据表明，临床医生在床边也可以安全、准确地进行超声检查。
测量床边即时超声（POCUS）评估 DVT 的医院内科医生的操作特征。
这是一项前瞻性队列研究，纳入了方便样本的患者。医院内科医生对 DVT 进行 POCUS 检查，结果与放射科医师解读的相应正式血管研究（FVS）进行比较。
四家三级保健医院住院的非 ICU 患者，这些患者需要进行 DVT 超声检查。
主要结局是 POCUS 压缩超声与 FVS 相比的敏感性、特异性和预测值。次要结局是从医嘱到 POCUS 研究的时间与从医嘱到正式放射学报告完成的时间相比。
73 名患者的 125 条肢体进行了扫描。DVT 的患病率为 6.4%（8/125）。POCUS 对 DVT 的敏感性为 100%（95%CI 74-100%），特异性为 95.8%（95%CI 91-98%），阳性预测值为 61.5%（95%CI 35-84%），阴性预测值为 100%（95%CI 98-100%）。从医嘱到 POCUS 完成的中位时间为 5.8 小时，而从医嘱到放射学报告完成的中位时间为 11.5 小时（p=0.001）。
医院内科医生可以对住院患者进行仅压缩式 POCUS 检查以评估 DVT，其准确性与其他专业和设置相似，结果比放射科更快获得。观察到的 DVT 患病率低于预期。POCUS 可能可靠地排除 DVT，但需要进一步研究确定如何将阳性 POCUS DVT 结果纳入临床实践。
