Servicio de Urgencias, Complejo Asistencial de Soria, España. Universidad de Valladolid, Facultad de Ciencias de la Salud, Valladolid, España.
Área de Urgencias, Hospital Clinic, IDIBAPS, Barcelona, España.
Emergencias. 2021 Dec;33(6):433-440.
To describe the characteristics of patients with isolated lower-limb superficial vein thrombosis (SVT) treated in hospital emergency departments and to evaluate adherence to clinical practice guidelines on diagnosis (vein ultrasound imaging) and therapeutic management (start of anticoagulant therapy).
Retrospective cohort study in 18 Spanish emergency departments. We included all patients with a final emergency department diagnosis of lower-limb SVT aged 18 years or older between January 2016 and May 2017. Backward stepwise multiple logistic regression analysis was used to evaluate adherence to clinical practice guidelines on ordering vein ultrasound imaging and starting anticoagulant therapy.
A total of 1166 patients were included. The mean patient age was 59.6 years, and 67.9% were women. About a quarter of the patients (24.4%) had a history of venous thromboembolic disease. Complications developed in 8.9% within 180 days: 4.6% experienced a recurrence and 3.6% progressed to SVT and 1.8% to deep vein thrombosis; pulmonary thromboembolism occurred in 0.9%. Hemorrhagic complications developed in 17 patients (1.5%). Sixteen patients (1.4%) died. Vein ultrasound imagine was ordered for 703 patients (60.3%). Anticoagulant agents were prescribed for 898 (77%) for a median period of 22 days. Variables associated with a decision to order anticoagulants were a history of venous thromboembolic disease (odds ratio [OR], 1.60; 95% CI, 1.12-2.30), varicose veins (OR, 1.40; 95% CI, 1.12-2.30); limb pain (OR, 1.44; 95% CI, 1.08-1.91); painful cord (OR, 1.30; 95% CI, 0.97-1.73); and availability of vein ultrasound images (OR, 1.60; 95% CI, 1.94-3.45).
Adherence to clinical practice guidelines for the diagnosis and treatment of isolated lower-limb SVT is low in Spanish emergency departments. Ultrasound imaging is not ordered for 1 out of every 2 to 3 patients, and anticoagulant treatment is not started in 1 out of 4 patients. There is great room for improvement.
描述在医院急诊科就诊的单纯下肢浅静脉血栓形成（SVT）患者的特征，并评估对诊断（静脉超声成像）和治疗管理（开始抗凝治疗）的临床实践指南的依从性。
这是一项在西班牙 18 家急诊科进行的回顾性队列研究。我们纳入了 2016 年 1 月至 2017 年 5 月期间年龄在 18 岁及以上、最终在急诊科诊断为下肢 SVT 的所有患者。采用向后逐步多元逻辑回归分析来评估对静脉超声成像和开始抗凝治疗的临床实践指南的依从性。
共纳入 1166 例患者。患者的平均年龄为 59.6 岁，67.9%为女性。约四分之一的患者（24.4%）有静脉血栓栓塞疾病史。180 天内发生并发症的患者占 8.9%：4.6%出现复发，3.6%进展为 SVT，1.8%进展为深静脉血栓形成，0.9%发生肺血栓栓塞症。17 例患者（1.5%）出现出血并发症。16 例患者（1.4%）死亡。703 例患者（60.3%）行静脉超声成像检查。898 例（77%）患者接受抗凝治疗，中位治疗时间为 22 天。与决定使用抗凝剂相关的变量包括静脉血栓栓塞疾病史（比值比[OR]，1.60；95%置信区间[CI]，1.12-2.30）、静脉曲张（OR，1.40；95%CI，1.12-2.30）、肢体疼痛（OR，1.44；95%CI，1.08-1.91）、疼痛性条索（OR，1.30；95%CI，0.97-1.73）和静脉超声成像结果（OR，1.60；95%CI，1.94-3.45）。
西班牙急诊科对单纯下肢 SVT 的诊断和治疗临床实践指南的依从性较低。每 2 至 3 例患者中就有 1 例未行超声检查，每 4 例患者中就有 1 例未开始抗凝治疗。仍有很大的改进空间。
