Accuracy of Ultrasonography Performed by Critical Care Physicians For The Diagnosis of DVT
Accuracy of Ultrasonography Performed by Critical Care Physicians For The Diagnosis of DVT
Accuracy of Ultrasonography Performed by Critical Care Physicians For The Diagnosis of DVT
CRITICAL CARE
Background: DVT is common among critically ill patients. A rapid and accurate diagnosis is essen-
tial for patient care. We assessed the accuracy and timeliness of intensivist-performed compres-
sion ultrasonography studies (IP-CUS) for proximal lower extremity DVT (PLEDVT) by comparing
results with the formal vascular study (FVS) performed by ultrasonography technicians and inter-
preted by radiologists.
Methods: We conducted a multicenter, retrospective review of IP-CUS examinations performed
in an ICU by pulmonary and critical care fellows and attending physicians. Patients suspected of
having DVT underwent IP-CUS, using a standard two-dimensional compression ultrasonography
protocol for the diagnosis of PLEDVT. The IP-CUS data were collected prospectively as part of a
quality-improvement initiative. The IP-CUS interpretation was recorded and timed at the end of
the examination on a standardized report form. An FVS was then ordered, and the FVS result was
used as the criterion standard for calculating sensitivity and specificity. Time delays between the
IP-CUS and FVS were recorded.
Results: A total of 128 IP-CUS were compared with an FVS. Eighty-one percent of the IP-CUS were
performed by fellows with , 2 years of clinical ultrasonography experience. Prevalence of DVT
was 20%. IP-CUS studies yielded a sensitivity of 86% and a specificity of 96% with a diagnostic
accuracy of 95%. Median time delay between the ordering of FVS and the FVS result was 13.8 h.
Conclusions: Rapid and accurate diagnosis of proximal lower extremity DVT can be achieved by
intensivists performing compression ultrasonography at the bedside. CHEST 2011; 139(3):538–542
Abbreviations: 2-D 5 two-dimensional; CFV 5 common femoral vein; FVS 5 formal vascular study; IP-CUS 5 intensivist-
performed compression ultrasonography study; PE 5 pulmonary embolism; PLEDVT 5 proximal lower extremity DVT;
PV 5 popliteal vein; SFV 5 superficial femoral vein