Comparison between two-point and three-point compression ultrasound for the diagnosis of deep vein thrombosis

SummaryThe clinical importance of asymptomatic proximal and distal deep vein thrombosis (DVT) remains uncertain and controversial. The aim of this retrospective,post-hoc analysis was to examine mortality and risk factors for development of proximal DVT in hospitalized patients with acute medical illness who were recruited into a randomized, prospective clinical trial of thromboprophylaxis with dalteparin (PREVENT).We analyzed 1738 patients who had not sustained a symptomatic venous thromboembolic event by Day 21 and who had a complete compression ultrasound of the proximal and distal leg veins on Day 21. We examined the 90-day mortality rates in patients with asymptomatic proximal DVT (Group I, N = 80), asymptomatic distal DVT (Group II, N = 118) or no DVT (Group III, N = 1540).The 90-day mortality rates were 13.75%, 3.39%, and 1.92% for Groups I–III, respectively. The difference in mortality between Group I and Group III was significant (hazard ratio 7.63, 95% CI = 3.8–15.3;p < 0.0001),whereas the difference between Groups II and III did not reach significance (hazard ratio 1.36, 95% CI = 0.41–4.45).The association of asymptomatic proximal DVT with increased mortality remained highly significant after adjusting for differences in baseline demographics and clinical variables. Risk factors significantly associated with the development of proximal DVT included advanced age (p = 0.0005), prior DVT (p = 0.001), and varicose veins (p = 0.04). In conclusion, the high mortality rate in patients with asymptomatic proximal DVT underscores its clinical relevance and supports targeting of asymptomatic proximal DVT as an appropriate endpoint in clinical trials of thromboprophylaxis.

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Diagnostic Accuracy of a Three-point Compression Ultrasonography Performed by Emergency Medicine Resident for the Diagnosis of Deep Vein Thrombosis: a Prospective Diagnostic Study

Acta Informatica Medica ◽

10.5455/aim.2019.27.119-122 ◽

2019 ◽

Vol 27 (2) ◽

pp. 119

Author(s):

Fatemeh Jahanian ◽

Iraj Khatir ◽

Elham Mostafavi ◽

Siavash Moradi ◽

Fatemeh Aghamalaki

Keyword(s):

Emergency Medicine ◽

Deep Vein Thrombosis ◽

Diagnostic Accuracy ◽

Diagnostic Study ◽

Emergency Medicine Resident ◽

Medicine Resident ◽

Vein Thrombosis ◽

Point Compression ◽

Deep Vein ◽

Compression Ultrasonography

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Non-invasive diagnosis of deep vein thrombosis from ultrasound imaging with machine learning

npj Digital Medicine ◽

10.1038/s41746-021-00503-7 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Bernhard Kainz ◽

Mattias P. Heinrich ◽

Antonios Makropoulos ◽

Jonas Oppenheimer ◽

Ramin Mandegaran ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Deep Learning ◽

Predictive Value ◽

Gold Standard ◽

Learning Algorithm ◽

Blood Clot ◽

Decision Algorithm ◽

Vein Thrombosis ◽

Compression Ultrasound ◽

Deep Vein

AbstractDeep vein thrombosis (DVT) is a blood clot most commonly found in the leg, which can lead to fatal pulmonary embolism (PE). Compression ultrasound of the legs is the diagnostic gold standard, leading to a definitive diagnosis. However, many patients with possible symptoms are not found to have a DVT, resulting in long referral waiting times for patients and a large clinical burden for specialists. Thus, diagnosis at the point of care by non-specialists is desired. We collect images in a pre-clinical study and investigate a deep learning approach for the automatic interpretation of compression ultrasound images. Our method provides guidance for free-hand ultrasound and aids non-specialists in detecting DVT. We train a deep learning algorithm on ultrasound videos from 255 volunteers and evaluate on a sample size of 53 prospectively enrolled patients from an NHS DVT diagnostic clinic and 30 prospectively enrolled patients from a German DVT clinic. Algorithmic DVT diagnosis performance results in a sensitivity within a 95% CI range of (0.82, 0.94), specificity of (0.70, 0.82), a positive predictive value of (0.65, 0.89), and a negative predictive value of (0.99, 1.00) when compared to the clinical gold standard. To assess the potential benefits of this technology in healthcare we evaluate the entire clinical DVT decision algorithm and provide cost analysis when integrating our approach into diagnostic pathways for DVT. Our approach is estimated to generate a positive net monetary benefit at costs up to £72 to £175 per software-supported examination, assuming a willingness to pay of £20,000/QALY.

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Die vollständige Kompressionssonographie zur Diagnose der proximalen und distalen Venenthrombose – eine retrospektive Untersuchung

VASA ◽

10.1024/0301-1526.30.4.253 ◽

2001 ◽

Vol 30 (4) ◽

pp. 253-257 ◽

Cited By ~ 3

Author(s):

Sebastian M. Schellong ◽

T. Schwarz ◽

T. Pudollek ◽

B. Schmidt ◽

H. E. Schroeder

Keyword(s):

Deep Vein Thrombosis ◽

Outcome Study ◽

Repeated Testing ◽

Clinical Safety ◽

Vein Thrombosis ◽

Clinical Probability ◽

Compression Ultrasound ◽

Low Incidence ◽

Deep Vein

Background: Compression ultrasound is considered the preferred test for the diagnosis of deep vein thrombosis of the leg (DVT). Since sensitivity for distal thrombosis is low additional tests are required. We developed a protocol of complete compression ultrasound of all venous segments of the leg (CCUS). A retrospective outcome study was performed to get an estimate of the rate of indeterminate results necessitating repeated testing as well as for the clinical safety of CCUS in a cohort of consecutive, unselected patients. Patients and methods: Case records of all patients referred for clinical suspicion of deep vein thrombosis within a three months period were reviewed. Patients with negative CCUS were followed directly or via the general practitioner in order to know whether an episode of venous thromboembolism had been documented since the initial CCUS. Results: 132 inpatients and 154 outpatients were identified. Clinical probability was high in 50 patients, medium in 142, and low in 94. The first CCUS was negative in 209 cases. Five patients (1,8%) had repeated CCUS within the next 7 days because of incomplete visualisation of the distal veins and turned out to be negative as well. Of all 214 patients with negative CCUS a clinical follow-up information was obtained after 168 ± 25 days. Five patients had died, none due to pulmonary embolism. In two patients deep vein thrombosis had been documented (0,9% [95% CI: 0,1–3,3%]) 148 and 172 days after CCUS, respectively. Conclusion: CCUS for diagnosis of DVT needs to be repeated in very few cases only. Clinical safety seems to fall into the same range as with combined algorithms and should be tested in a prospective design. Patients with medium and high probability showed a very low incidence of DVT within three months following CCUS; therefore, they may be included in a prospective outcome study.

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