Anthonie W.A. Lensing, MD; Marcel M. Levi, MD; Harry R. Büller, MD, PhD; Paolo Prandoni, MD; Mario Vigo, MD; Giancarlo Agnelli, MD; Luciano Lupatelli, MD; Menno V. Huisman, MD, PhD; Jan Wouter ten Cate, MD, PhD
Study Objective: To determine the diagnostic criteria (phase I) and to assess the accuracy (phase II) of an objective Doppler-Valsalva pressure method as compared with contrast venography for the diagnosis of acute deep-leg-vein thrombosis in symptomatic outpatients.
Design: A two-phase prospective study in consecutive patients. Doppler ultrasound strip-chart recordings and venograms were independently analyzed by experienced observers.
Setting: Referral-based medical clinics at university medical centers.
Patients: One hundred and ten (phase I) and one hundred and fifty-five (phase II) patients who had clinically suspected venous thrombosis and were referred by their general practitioners were included.
Methods and Measurements: A normal Doppler test result was defined as a cyclic spontaneous signal (S-signal), a continuous S-signal with a Valsalva pressure of less than 6.5 mm Hg, or an absent S-signal with flow after cessation of the Valsalva maneuver. A continuous S-signal with a Valsalva pressure of 6.5 mm Hg or more or an absent S-signal without flow after cessation of the Valsalva maneuver were defined as abnormal test results. The accuracy indices for proximal vein thrombosis in phase II (155 patients; prevalence, 31%) were sensitivity, 91% (95% CI, 79% to 98%), and specificity, 99% (CI, 97% to 100%). All 3 patients with isolated calf-vein thrombosis had normal Doppler test results.
Conclusions: The objective Doppler method is an accurate, reproducible, and simple method for detection of venous thrombosis in symptomatic outpatients.
Lensing AW, Levi MM, Büller HR, Prandoni P, Vigo M, Agnelli G, et al. Diagnosis of Deep-Vein Thrombosis Using an Objective Doppler Method. Ann Intern Med. ;113:9–13. doi: 10.7326/0003-4819-113-1-9
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Published: Ann Intern Med. 1990;113(1):9-13.
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