Royal Columbian Hospital and Eagle Ridge Hospital
Academics

ED Ultrasound for Lower Extremity DVT

We are conducting this Emergency Department study to determine the sensitivity & specificity of US performed by ED physicians & residents compared to formal US for DVT in hopes of improving patients' hospital experience while maintaining quality of care.

Research Team

  1. Dr. Tong Vi Lam, BSc(Engineering), MD, PGY-4 (Emergency), University of Alberta
  2. Dr. Jonathan Theoret, MDCM, FRCPC (Emergency), Clinical Instructor, Department of Emergency Medicine, University of British Columbia
  3. Dr. Adam Lund, BSc, MDE, MD, FRCPC (Emergency), Clinical Associate Professor, Department of Emergency Medicine, University of British Columbia

Background:

Management of patients presenting to the emergency department (ED) with suspected deep venous thrombosis (DVT) can often be challenging due to the limited availability of formal ultrasonography. In recent years, the applications of ED ultrasound (EDUS) have expanded to include evaluation for DVT. Currently several studies conducted in the United States and internationally have demonstrated high sensitivities and specificities of EDUS for the detection of lower extremity DVT. Similar studies have not been undertaken in Canadian emergency departments. In the future, if a sufficient number of studies show high sensitivity and specificity compared to formal US, EDUS may become a useful adjunct and/or a primary diagnostic modality for the management of patients suspected of having a DVT.

Hypothesis:

US performed by ER physicians and residents after a 30-minute training session has a high sensitivity and specificity compared to formal US for the assessment of lower extremity DVT.

Inclusion & Exclusion Criteria:

Inclusion:

  • ≥ 19 years old
  • Patient with suspected DVT who will get formal confirmatory ultrasound within the next 24 hours
  • Patients who will be discharged home or admitted to hospital

Exclusion:

  • Known DVT or previous DVT in last 6 months
  • Hemodynamic instability
  • Altered mental status

Potential Impact:

The uses of EDUS are continually expanding as more research is conducted to show its utility and diagnostic accuracy with specific disease entities. With the growing number of studies showing that EDUS is highly sensitive and specific for imaging for lower extremity DVT, it may eventually become a primary diagnostic tool as part of a regimented DVT management protocol. Our study will hopefully add to the pool of data that will strengthen this argument. In addition, since formal US is not available in the evenings and weekends, it would be more efficient to be able to perform a quick bedside US and decide on a substantiated management plan immediately. This would obviate the need for the patient to return to the hospital for further testing. In the future, EDUS for DVT may decrease the number of negative formal ultrasound studies, which represents a large burden for diagnostic imaging departments and constitutes a significant healthcare cost.

File icon EDUS DVT Study.pdf 710.76 kB