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Diagnostic Efficacy of Impedance Plethysmography for Clinically Suspected Deep-Vein Thrombosis: A Randomized Trial

RUSSELL D. HULL, M.B.B.S., M.Sc.; JACK HIRSH, M.D.; CEDRIC J. CARTER, M.B.B.S.; RICHARD M. JAY, M.D.; PAUL A. OCKELFORD, M.B.B.S.; HARRY R. BULLER, M.D., Ph.D.; A. GRAHAM TURPIE, M.B.Ch.B.; PETER POWERS, M.D.; DENISE KINCH, B.A.; PEARL E. DODD; GERALD J. GILL, M.D.; JACQUES R. LECLERC, M.D.; and MICHAEL GENT, M.Sc.
[+] Article and Author Information

Grant support: by grants from the Province of Ontario and the Ontario and Canadian Heart Foundations.

▸Requests for reprints should be addressed to Dr. Russell Hull, M.B.B.S.; Chedoke Hospital, Patterson Building, 4th Floor, P.O. Box 2000, Station A; Hamilton, Ontario, Canada L8N 3Z5.


Hamilton, Ontario, Canada


© 1985 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1985;102(1):21-28. doi:10.7326/0003-4819-102-1-21
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Impedance plethysmography is an accurate noninvasive method to test for proximal vein thrombosis, but it is insensitive to calf-vein thrombi. We randomly assigned patients on referral with clinically suspected deep-vein thrombosis and normal impedance Plethysmographic findings to either serial impedance plethysmography alone or combined impedance plethysmography and leg scanning (which has been shown to be essentially as sensitive as venography) and compared the long-term outcomes. During the initial surveillance, deep-vein thrombosis was detected in 6 of 311 patients (1.9%) tested by serial impedance plethysmography alone and in 30 of 323 patients (9.3%) (most with calf-vein thrombi) tested by the combined approach (p < 0.001). During long-term follow-up, no patient died from pulmonary embolism; but 6 patients (1.9%; 95% confidence limits, 0.7% to 4.2%) tested by serial impedance plethysmography developed deep-vein thrombosis compared with 7 patients (2.2%; 95% confidence limits, 0.9% to 4.4%) tested by the combined approach. Serial impedance plethysmography used alone is an effective strategy to evaluate such symptomatic patients.

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