Bruce L. Davidson, MD, MPH; C. Gregory Elliott, MD; Anthonie W. A. Lensing, MD, PhD; RD Heparin Arthroplasty Group*>
Davidson BL, Elliott CG, Lensing AWA, RD Heparin Arthroplasty Group*>. Low Accuracy of Color Doppler Ultrasound in the Detection of Proximal Leg Vein Thrombosis in Asymptomatic High-Risk Patients. Ann Intern Med. 1992;117:735-738. doi: 10.7326/0003-4819-117-9-735
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Published: Ann Intern Med. 1992;117(9):735-738.
▪ Objective: To evaluate the ability of color Doppler ultrasound to detect proximal deep venous thrombosis (DVT) in asymptomatic high-risk patients who subsequently underwent contrast venography.
▪ Design: Prospective cohort study using blinded observers, with contrast venography as the comparison standard.
▪ Setting: Seven medical centers (university and community hospitals) participating in a clinical trial of low-molecular-weight heparin for prevention of DVT.
▪ Patients: A total of 385 consecutive patients undergoing elective unilateral hip or knee replacement.
▪ Measurements: Ten days after surgery or before hospital discharge (whichever occurred first), patients had bilateral color Doppler ultrasound examinations of the proximal veins of the lower extremities. Subsequently, a contrast venogram of the operated leg was obtained.
▪ Results: Color Doppler ultrasound studies and venograms were both evaluable in 319 of the 385 patients. Deep venous thrombosis was identified by contrast venography in 80 patients (prevalence, 25%; 95% Cl, 20% to 30%) and involved the proximal veins in 21 patients (prevalence, 7%; Cl, 4% to 10%). For proximal DVT, color Doppler ultrasound showed poor sensitivity (38%; Cl, 18% to 62%), moderately good specificity (92%; Cl, 89% to 95%), and a poor positive predictive value for this population (26%).
▪ Conclusion: Color Doppler ultrasound examinations are insensitive to proximal DVT in asymptomatic high-risk patients and should not be substituted for venography for identifying proximal DVT in such patients.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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