Division of Vascular Surgery, Department of Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore.
Division of Vascular Surgery, Department of Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore; Department of Research and Development, Portland Department of Veterans Administration Health Care System, Portland, Ore.
J Vasc Surg Venous Lymphat Disord. 2021 Nov;9(6):1460-1466. doi: 10.1016/j.jvsv.2021.01.014. Epub 2021 Feb 3.
A lower extremity venous duplex ultrasound (LEVDUS) examination is the standard diagnostic test to evaluate patients for lower extremity deep vein thrombosis (DVT). However, some studies will be incomplete for a variety of reasons, including patient-related factors such as pain, edema, a large leg circumference, or the presence of overlying bandages or orthopedic devices. We previously reported that the frequency of obtaining a follow-up examination after an incomplete and negative (I/N) LEVDUS examination was low but that the rates of DVT found on the follow-up studies of initially I/N LEVDUS studies were similar to the rates of DVT found with initially complete LEVDUS examinations. Therefore, we recommended process improvements to increase follow-up LEVDUS studies after an I/N LEVDUS examination. In the present study, we have described the results of appending a recommendation to obtain a follow-up LEVDUS study to preliminary and final reports of I/N LEVDUS.
Starting in January 2019 through December 2019, a recommendation to obtain a repeat LEVDUS examination after an I/N study was appended to the preliminary and final reports of all I/N LEVDUS examination of patients who did not, otherwise, have an indication for anticoagulation (group 2). The patients were identified on an ongoing basis through the study period and entered into an Excel database (Microsoft Corp, Redmond, Wash). Group 2 was compared with a previously reported historic control cohort of patients identified from January 2017 to December 2017 (group 1). We compared groups 1 and 2 with respect to the frequency of the repeat studies performed within 4 weeks after an I/N LEVDUS examination and the DVT rates found from the follow-up LEVDUS examinations after an I/N LEVDUS study.
Of the patients in groups 1 and 2, 187 and 229 had had I/N LEVDUS examinations, with 28% and 40.2% of group 1 and 2 studies having follow-up LEVDUS examinations (P < .01). Previously unidentified lower extremity thrombi were discovered in 21% of the group 2 follow-up examinations. Also, the rate of new thrombi detected was not different between groups 2 and 1 (historic controls; DVT, 14.3% vs 18.5% [P = .25]; SVT, 6.3% vs 3.3% [P = .15]). A definitive finding of either positive or negative for DVT and SVT with a complete examination in 50% of the group 2 patients with follow-up examinations.
A recommendation to obtain a follow-up examination appended to the preliminary and final I/N LEVDUS reports was associated with an increased rate of follow-up examinations, which revealed many previously undetected DVTs and SVTs or had allowed for definitive exclusion of DVT.
下肢静脉双功能超声（LEVDUS）检查是评估下肢深静脉血栓形成（DVT）患者的标准诊断测试。然而，由于各种原因，一些研究可能不完整，包括与患者相关的因素，如疼痛、肿胀、大腿周长较大，或存在绷带或矫形设备。我们之前报告过，在不完整和阴性（I/N）LEVDUS 检查后进行随访检查的频率较低，但在最初 I/N LEVDUS 研究的随访研究中发现的 DVT 率与最初完整的 LEVDUS 检查发现的 DVT 率相似。因此，我们建议改进流程，以增加 I/N LEVDUS 检查后的随访 LEVDUS 检查。在本研究中，我们描述了在初步和最终的 I/N LEVDUS 报告中添加进行随访 LEVDUS 检查建议的结果。
从 2019 年 1 月至 2019 年 12 月，对没有抗凝指征的所有 I/N LEVDUS 检查患者（组 2）的初步和最终报告中添加了进行重复 LEVDUS 检查的建议。通过研究期间的持续研究确定了这些患者，并将其输入到 Excel 数据库（微软公司，雷德蒙德，华盛顿）中。组 2 与之前报告的 2017 年 1 月至 2017 年 12 月确定的历史对照组患者（组 1）进行比较。我们比较了组 1 和 2 在 I/N LEVDUS 检查后 4 周内进行重复检查的频率，以及 I/N LEVDUS 检查后的随访 LEVDUS 检查中发现的 DVT 率。
组 1 和 2 中有 187 例和 229 例进行了 I/N LEVDUS 检查，组 1 和 2 中有 28%和 40.2%的研究进行了随访 LEVDUS 检查（P<.01）。在组 2 的随访检查中发现了 21%之前未识别的下肢血栓。此外，组 2 和组 1 之间新血栓的检出率无差异（历史对照组；DVT，14.3%比 18.5%[P=.25]；SVT，6.3%比 3.3%[P=.15]）。在组 2 中有随访检查的患者中，有 50%通过完整检查确定了 DVT 和 SVT 的阳性或阴性的明确诊断。
在初步和最终的 I/N LEVDUS 报告中添加进行随访检查的建议与随访检查率的增加相关，这发现了许多之前未检测到的 DVT 和 SVT，或者允许明确排除 DVT。
