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- Title
Low accuracy of color Doppler ultrasound in the detection of proximal leg vein thrombosis in asymptomatic high-risk patients. The RD Heparin Arthroplasty Group.
- Authors
Davidson, Bruce L.; Elliott, C. Gregory; Lensing, Anthonie W.A.; Davidson, B L; Elliott, C G; Lensing, A W
- Abstract
<bold>Objective: </bold>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.<bold>Design: </bold>Prospective cohort study using blinded observers, with contrast venography as the comparison standard.<bold>Setting: </bold>Seven medical centers (university and community hospitals) participating in a clinical trial of low-molecular-weight heparin for prevention of DVT.<bold>Patients: </bold>A total of 385 consecutive patients undergoing elective unilateral hip or knee replacement.<bold>Measurements: </bold>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.<bold>Results: </bold>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% CI, 20% to 30%) and involved the proximal veins in 21 patients (prevalence, 7%; CI, 4% to 10%). For proximal DVT, color Doppler ultrasound showed poor sensitivity (38%; CI, 18% to 62%), moderately good specificity (92%; CI, 89% to 95%), and a poor positive predictive value for this population (26%).<bold>Conclusion: </bold>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.
- Subjects
DOPPLER ultrasonography; VENOUS thrombosis diagnosis; PREVENTION of surgical complications; VENOUS thrombosis prevention; WARFARIN; ARTIFICIAL joints; COLOR; HEPARIN; SURGICAL complications; VENOUS thrombosis; ULTRASONIC imaging; VENOGRAPHY; PREDICTIVE tests
- Publication
Annals of Internal Medicine, 1992, Vol 117, Issue 9, p735
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-117-9-735