Hannula Ossi, Vanninen Ritva, Rautiainen Suvi, Mattila Kalle, Hyppölä Harri
Central Finland Central Hospital, Jyväskylä, Finland.
University of Eastern Finland, Kuopio, Finland.
Ultrasound J. 2021 Feb 2;13(1):1. doi: 10.1186/s13089-021-00204-y.
The aim of this study was to retrospectively determine whether teaching limited compression ultrasound (LCUS) to general practitioners (GP) would reduce the number of patients with a suspected lower extremity DVT referred to a hospital for ultrasound (US) examination. According to the current literature, an LCUS protocol is a safe way to diagnose or exclude lower extremity deep venous thrombosis (DVT) and a good option to radiologist-performed whole-leg ultrasound (US), especially in remote health care units where there may be a limited availability of radiological services.
Between 2015 and 2016, altogether 13 GPs working in the same primary care unit were trained in LCUS for DVT diagnostics. The number of annual referrals due to a suspected DVT from Saarikka primary care unit to the closest hospital was evaluated before and after training. The incidence of DVT was considered to be constant. Thus, the reduction of referrals was attributed to the fact that these patients were diagnosed and treated in primary health care. Incidence rate ratio of hospital referrals was calculated. As a measure of safety, all patients diagnosed with a pulmonary embolism in the nearest hospital were evaluated to determine if they had undergone LCUS by a GP in primary care.
Before training in 2014, there were 60 annual referrals due to a suspected DVT; in 2017, after training, the number was reduced to 16, i.e., a 73.3% decrease. The incidence of referrals decreased from 3.21 to 0.89 per 1000 person-years. (IRR 3.58, 95% CI 2.04-6.66, p < 0.001). No patient with a pulmonary embolism diagnosis had LCUS performed previously, indicating that there were no false negatives, resulting in pulmonary embolism.
Teaching LCUS to GPs can safely reduce the number of patients with a suspected DVT referred to a hospital substantially.
本研究的目的是回顾性地确定向全科医生（GP）传授有限压迫超声（LCUS）技术是否会减少因怀疑下肢深静脉血栓形成（DVT）而被转诊至医院进行超声（US）检查的患者数量。根据当前文献，LCUS方案是诊断或排除下肢深静脉血栓形成（DVT）的一种安全方法，也是放射科医生进行全腿超声检查的一个不错选择，尤其是在放射科服务可能有限的偏远医疗单位。
2015年至2016年期间，共有13名在同一基层医疗单位工作的全科医生接受了LCUS用于DVT诊断的培训。评估了培训前后从萨里卡基层医疗单位因怀疑DVT转诊至最近医院的年度转诊数量。DVT的发病率被认为是恒定的。因此，转诊数量的减少归因于这些患者在基层医疗保健机构得到了诊断和治疗。计算了医院转诊的发病率比。作为安全性的一项衡量指标，对最近医院诊断为肺栓塞的所有患者进行评估，以确定他们是否在基层医疗中接受过全科医生的LCUS检查。
2014年培训前，每年因怀疑DVT有60例转诊；2017年培训后，该数量降至16例，即减少了73.3%。转诊发病率从每1000人年3.21例降至0.89例。（发病率比3.58，95%置信区间2.04 - 6.66，p < 0.001）。没有肺栓塞诊断患者之前接受过LCUS检查，表明没有假阴性结果导致肺栓塞。
向全科医生传授LCUS技术可安全地大幅减少因怀疑DVT而转诊至医院的患者数量。
