DVT affects 1 in 1000 patients, and is a huge burden on all front-line physicians, both in emergency departments and in primary care.1 It is found in 10–25% of patients in whom it is suspected.
The diagnosis of proximal DVT is key in preventing pulmonary embolism and post-thrombotic syndrome.
Focused ultrasound is performed using 3-point compression in those areas of highest turbulence and at greatest risk of developing thrombus:
A recent meta-analysis of 16 studies of emergency physician-performed ultrasonography in the diagnosis of DVT has shown a weighted mean sensitivity of 96% and weighted mean specificity of 97%.2
Dr Paramjeet Deol, Consultant Emergency Physician at Chelsea and Westminster Hospital, London
The standard technique identified 33 DVTs in 16 patients after scanning the iliac, femoral, popliteal, peroneal, tibial and soleal veins. All of the DVTs were also detected using the pocket-size ultrasound, resulting in a sensitivity and specificity of 100%.
Nakanishi K, et al. Detection of deep venous thrombosis using a pocket-size ultrasound examination device. JACC Cardiovasc Imaging. 2016;9(7):897-8.
Based on data gathered through shadowing at a hospital’s DVT department over two days, the authors mapped a typical patient’s pathway through the hospital’s current system and suggested ways in which it could be optimised. The study found that there is a delay in patients receiving the ultrasound scan, which can lead to issues surrounding the self-administration and cost of low-molecular-weight heparin. The authors consider having nurse-led ultrasound procedures as a key component in improving the DVT patient journey.
Koizi P, et al. Improving the outcomes of deep vein thrombosis: optimising the diagnostic pathway. Thrombus. 2016;20(3):43-5.