Tung-Chen Y, Pizarro I, Rivera-Núñez A, Martínez-Virto A, Lorenzo-Hernández A, Sancho-Bueso T, Rodríguez-Dávila M A, Fernández-Capitán C, Villén-Villegas T
Department of Emergency Medicine, Hospital Universitario La Paz, Madrid, Spain.
Department of Family and Community Medicine, Hospital Universitario La Paz, Madrid, Spain.
Ultrasound. 2020 Feb;28(1):23-29. doi: 10.1177/1742271X19865000. Epub 2019 Jul 29.
Venous thromboembolism is a common disease seen in the emergency department and a cause of high morbidity and mortality, constituting a major health problem.
To assess the potential benefit of follow-up ultrasound of patients who attended the emergency department with suspected superficial venous thrombosis or deep venous thrombosis and were found to have an initial negative whole-leg (or arm) ultrasound study.
This retrospective study included patients aged 18 years or older who were consecutively referred to a thrombosis clinic from the emergency department, with abnormal D-dimer test and moderate to high pre-test probability of deep venous thrombosis (Well's score ≥ 1), but a negative whole-leg (or arm) ultrasound. Demographic characteristics, symptom duration, laboratory and ultrasound data were recorded. At one-week follow-up, an experienced physician repeated ultrasound, and recorded the findings.
From January 2017 to April 2018, 54 patients were evaluated. The mean age was 66.8 years (SD 15.0) and 63% were women. The average D-dimer was 2159.9 (SD 3772.0) ng/mL. Ultrasound abnormalities were found in 12 patients (22.2%; 95% confidence interval of 12.5 to 36.0%), with 4 patients having proximal deep venous thrombosis, distal deep venous thrombosis in 2 patients and superficial venous thrombosis in 6 patients. We did not find any significant differences in demographic characteristics, venous thromboembolism risk factors or laboratory parameters between patients with negative and positive follow-up ultrasound.
These preliminary findings suggest that a negative whole-leg (or arm) ultrasound in addition to an abnormal D-dimer in moderate to high deep venous thrombosis pretest probability patients, might be an insufficient diagnostic approach to exclude suspected deep venous thrombosis or superficial venous thrombosis. Confirmation of this higher than expected prevalence would support the need to repeat one-week ultrasound control in this population.
静脉血栓栓塞是急诊科常见疾病，是高发病率和高死亡率的一个原因，构成一个重大的健康问题。
评估对因疑似浅静脉血栓形成或深静脉血栓形成就诊于急诊科且初始全腿（或全臂）超声检查结果为阴性的患者进行超声随访的潜在益处。
这项回顾性研究纳入了年龄在18岁及以上、从急诊科连续转诊至血栓门诊的患者，这些患者D-二聚体检测异常且深静脉血栓形成的检测前概率为中度至高度（Well评分≥1），但全腿（或全臂）超声检查结果为阴性。记录人口统计学特征、症状持续时间、实验室检查和超声检查数据。在一周随访时，由一名经验丰富的医生重复进行超声检查，并记录检查结果。
2017年1月至2018年4月，共评估了54例患者。平均年龄为66.8岁（标准差15.0），63%为女性。平均D-二聚体为2159.9（标准差3772.0）ng/mL。12例患者（22.2%；95%置信区间为12.5%至36.0%）发现超声异常，其中4例为近端深静脉血栓形成，2例为远端深静脉血栓形成，6例为浅静脉血栓形成。我们未发现随访超声检查结果为阴性和阳性的患者在人口统计学特征、静脉血栓栓塞危险因素或实验室参数方面存在任何显著差异。
这些初步研究结果表明，对于深静脉血栓形成检测前概率为中度至高度且D-二聚体异常的患者，仅全腿（或全臂）超声检查结果为阴性可能不足以排除疑似深静脉血栓形成或浅静脉血栓形成。对这一高于预期的患病率的确认将支持对该人群进行一周超声复查的必要性。
