• Hylmar E Elsenga, Annelieke Collée, and Arthur V Rosendaal.
• Department of Emergency Medicine, Franciscus Hospital, Rotterdam, The Netherlands.
• Eur J Emerg Med. 2021 Jan 1; 28 (1): 25-28.

IntroductionThe time factor in diagnosis and management of a deep vein thrombosis of the lower extremities (LE DVT) is of increasing importance in the era of crowding of emergency departments (ED). Current techniques used to detect LE DVT include a two-point regional compression ultrasound (rCUS), yet assessments are usually performed only during office hours. Outside office hours ultrasonography is postponed and low molecular weight heparin (LMWH) prescribed.ObjectivesPrimary outcome of the study was to assess the level of agreement in rCUS for LE DVT when performed by Dutch emergency physicians compared to rCUS by a radiologist. Secondary outcome was time to diagnosis.MethodWe performed a single-blind cohort study. All consecutive patients aged 18 years and older attending the ED with clinical suspicion of LE DVT were considered eligible for study enrolment. rCUS was ordered at the radiology department; subsequently, the bedside rCUS examination was also performed in the ED by the emergency physicians or ED residents.ResultsA total of 138 patients were included, of whom 28 patients were diagnosed with DVT by a radiologist. Emergency physicians and radiologists showed comparable agreement [absolute agreement 94% (P < 0.001), Cohen's Kappa 0.87]. Emergency physicians decreased overall time to diagnosis by 01:04 h, ED residents showed comparable results. During out-of-office hours, time benefit was 16:39 h on weekdays and 18:40 h during weekends.ConclusionEmergency physicians show comparable agreement in diagnosing LE DVT using rCUS when compared to radiologists. Average time benefit is over an hour, thereby reducing unnecessary waiting and improving time to disposition. ED residents demonstrated similar results in both agreement and time-saving.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

12 keywords...

hide…