Variations in ultrasound scanning protocols in the UK for suspected deep vein thrombosis in outpatients

2013 ◽  
Vol 28 (8) ◽  
pp. 397-403
Author(s):  
F Shahi ◽  
K Murali
Keyword(s):  
Health Care ◽  
Deep Vein Thrombosis ◽  
Health Care Professionals ◽  
Free Text ◽  
Ultrasound Scanning ◽  
Vein Thrombosis ◽  
Vascular Ultrasound ◽  
The United Kingdom ◽  
The Uk ◽  
Deep Vein

Aims To assess current ultrasound scanning protocol in outpatients with suspected deep vein thrombosis (DVT), in particular whether practitioners routinely scanned calf veins. Methods A standard questionnaire was sent out via post to all radiology departments in the United Kingdom (UK) and via the British Medical Ultrasound Society (BMUS) website in 2010. Responses were entered into Access® and database queries were run to analyse responses. Free-text comments were taken into account in our analysis. Results A total of 277 responses (50 through the BMUS website) were received (46% postal response rate). Of them, six were excluded as these were incomplete. Thus, 97 (36%) were consultants, 13 (5%) accredited vascular scientists (AVSs), 153 (56%) sonographers and six (2%) higher radiology trainees. All AVSs scanned the whole limb and used all three modalities of compression, colour and pulse wave Dopplers. Practice across other healthcare professionals varied. In all, 120/176 (68%) of other health-care professionals trained in vascular ultrasound scanned the whole limb routinely and 82/120 of these used all three scanning modalities. Trained sonographers scanned the whole limb significantly more than the medical cohort (P = 0.017). The use of all three modalities varied significantly between AVS and the non-AVS trained professionals (P = 0.0194), the trained medical cohort of consultants and sonographers (P = 0.0001), and trained and non-trained respondents (P = 0.0113). The commonly chosen reason for not scanning the whole limb was that it had poor sensitivity for calf vein DVTs. Free-text reasons for not scanning the whole limb routinely included local protocols prohibiting it. Conclusions There is a discrepancy between the scanning protocols of medically trained and allied health-care professionals, trained or otherwise in vascular ultrasound, and between these groups and AVSs. This is likely to have an impact on clinical governance.

Diagnosis of deep-vein thrombosis: Adherence to guidelines and outcomes in real-world health care

2009 ◽  
Vol 102 (12) ◽  
pp. 1234-1240 ◽  
Author(s):  
Horst Gerlach ◽  
Viola Hach-Wunderle ◽  
Eberhard Rabe ◽  
Hanno Riess ◽  
Heike Carnarius ◽  
...  
Keyword(s):  
Health Care ◽  
Deep Vein Thrombosis ◽  
Ambulatory Care ◽  
Real World ◽  
Diagnostic Methods ◽  
World Health ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Work Up ◽  
Current Guidelines

SummaryCurrent guidelines recommend optimised algorithms for diagnosis of suspected deep-vein thrombosis (DVT). There is little data to determine to what extent real-world health care adheres to guidelines, and which outcome in terms of diagnostic efficiency and safety is achieved. This registry involved patients with clinically suspected DVT of the leg recruited in German ambulatory care between October and December 2005. Registry items were: diagnostic methods applied; diagnostic categories at day 1; and venous thromboembolic events up to 90 days in patients without firmly established DVT. A total of 4,976 patients were recruited in 326 centres. Venous ultrasonography was performed in 4,770 patients (96%), D-dimer assay in 1,773 patients (36%) and venography in 288 patients (6%). At day 1, DVT was confirmed in 1,388 patients (28%), and ruled out in 3,389 patients (68%), and work-up was inconclusive in 199 patients (4%).The rate of venous thromboembolism at 90 days was 0.34% (95% confidence interval [CI]: 0.09 to 0.88) in patients in whom the diagnosis of DVT had been ruled out, and 2.50% (95% CI: 0.69 to 6.28) in patients with inconclusive diagnostic workup. This nationwide evaluation in German ambulatory care revealed that the diagnostic work-up for suspected DVT did not adhere to current guidelines. However, the overall diagnostic safety was excellent, although there is potential for improvement in a well defined minority of patients.The TULIPA registry was funded by GlaxoSmithKline GmbH und Co KG, Munich.

Repeat duplex ultrasound scanning in suspected Deep Vein Thrombosis (DVT): putting the onus back on the referring clinician

2016 ◽  
Vol 15 (2) ◽  
pp. 63-67
Author(s):  
Bryan Renton ◽  
S Thiru ◽  
CP Griffin
Keyword(s):  
Deep Vein Thrombosis ◽  
Duplex Ultrasound ◽  
Ultrasound Scanning ◽  
Nice Guideline ◽  
Vein Thrombosis ◽  
Dramatic Rise ◽  
Wells Score ◽  
Deep Vein ◽  
Repeat Scanning ◽  
D Dimer

Duplex scanning is utilised by many departments in the investigation of suspected Deep Vein Thrombosis (DVT). NICE Guideline CG144 recommended repeat scanning for patients in whom the initial Wells score was ‘likely’ in the presence of a raised D-Dimer, following a normal first scan. Following implementation of this recommendation in our department there was a dramatic rise in the number of repeat scans being undertaken, all of which were negative for DVT. Introduction of an electronic message to the report, placing the onus back on the referring clinician to arrange repeat scan if deemed appropriate resulted in a fall in the number of scans being undertaken without impacting on patient outcome.

scholarly journals Is bilateral ultrasound scanning of the legs necessary for patients with unilateral symptoms of deep vein thrombosis?

2001 ◽  
Vol 34 (5) ◽  
pp. 792-797 ◽  
Author(s):  
Nicholas D. Garcia ◽  
Mark D. Morasch ◽  
James L. Ebaugh ◽  
Somal Shah ◽  
Donna Blackburn ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Ultrasound Scanning ◽  
Vein Thrombosis ◽  
Deep Vein

scholarly journals Deep Vein Thrombosis, Demographic Characteristics and Risk Factors in Iran

2013 ◽  
Vol 2 (4) ◽  
pp. 135-140
Author(s):  
Shokoufeh Hajsadeghi ◽  
Scott Reza Jafarian Kerman ◽  
Rashin Joodat ◽  
Maral Hejratie ◽  
Helen Vaferi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Deep Vein Thrombosis ◽  
Health Care Systems ◽  
Care Providers ◽  
Female Ratio ◽  
Vein Thrombosis ◽  
Significant Difference ◽  
Care Systems ◽  
Deep Vein

Background: Deep vein thrombosis (DVT) can be an ethnicity related disease and an important health issue for health-care systems. Thus, domestic recognition of risk factors and disease characteristics seem to be inevitable. This study was designed to evaluate the epidemiology, basic characteristics, and risk factors in patients with DVT.Materials and Methods: In this descriptive cross-sectional study, all patients with primary or final diagnosis of DVT, confirmed by Doppler ultrasound in a 5-year period were included. Demographic data and prognosis were extracted from medical files. To evaluate the outcome of the patients after discharge, a phone-call follow-up was performed for all available patients.Results: Three-hundred seventy-one DVT patients were included with 232/139 male to female ratio. The mean age was 55.72±20.01 years with significant difference between genders (p=0.006). Mean weight was 88.97±10.2 kg with no significant difference between genders (p=0.74). The most common affected veins were common femoral vein (257 cases, 69.2%), followed by Popliteal, iliac, axillary, and subclavian veins. No season preference was seen in DVT occurrence. One-year survival of the patients after discharge was 92.6% and two-year survival was 87.7%.Conclusion: By knowing local information about this disease, health-care providers can give accurate warnings and suggestions to prevent the probable thrombosis chances. As Iran lacked information about DVT characteristics, this study can be an epidemiologic guide for health-care systems and an opening path for future studies.

A Simple Way to Improve DVT Protocol Compliance

2002 ◽  
Vol 16 (3) ◽  
pp. 121-124 ◽  
Author(s):  
M. E. Birks ◽  
S. Aiono ◽  
T. R. Magee ◽  
R. B. Galland
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Low Dose ◽  
District General Hospital ◽  
Vein Thrombosis ◽  
The United Kingdom ◽  
Raising Awareness ◽  
Protocol Compliance ◽  
Deep Vein ◽  
The Impact

Objective: To assess the impact on deep vein thrombosis (DVT) protocol violations of the introduction of a label attached to the patient's drug chart, which specifically allows low-dose subcutaneous heparin or thromboembolic deterrent stockings (TEDS) to be prescribed as appropriate. Design: An audit study. Setting: Department of General Surgery of a District General Hospital in the United Kingdom. Method: All adult general surgical inpatients on a Weekday were studied. Staff were not forewarned of the studies. Patient details and risk factors for DVT were noted. Details of administered DVT prophylaxis were recorded. In total four separate studies were undertaken, namely: with original protocols (I), with refined protocol 1 and 3 years later (II, III) and finally after introduction of the label (IV). Results: Protocol violations were defined as being ‘acceptable’ or ‘unacceptable’. Raising awareness between studies I and II reduced acceptable violations to zero. There was no statistically significant reduction in unacceptable violations (24 in 80 patients, 1; 17 in 75, II; 13 in 60, III). In study IV, following introduction of the label, there were only 6 violations in 51 patients ( p<0.02). Conclusion: Combining increased awareness with the attachment of a label to the drug chart reduced unacceptable violations by 63%.

Urokinase Treatment In Acute And Subacute Deep Vein Thrombosis

1981 ◽  
Author(s):  
G Trübestein ◽  
Th Brecht ◽  
M Ludwig ◽  
G Brecht ◽  
F Etzel
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Side Effects ◽  
Initial Dose ◽  
Fibrinolytic Therapy ◽  
Thrombin Time ◽  
Vein Thrombosis ◽  
The Uk ◽  
Deep Vein ◽  
Medium Dose

So far 74 patients with acute and subacute Deep Vein Thrombosis (DVT) were treated with a standardized Urokinase (UK) heparin scheme. From these patients 19 patients had a 1-6 day and 55 patients a 1-6 week old thrombosis of the iliac, femoral, popliteal or subclavian veins. The initial dose of the UK regimen was mostly 250.000 IU UK/10 min; the maintenance dose was 1.000.000 IU UK/24h in 40 patients, 1.500.000 IU UK/24h in 12 patients and 2.000.000 IU UK/24h in 22 patients. Heparin was given from the very beginning, starting with a dose of 1.000 IU/h. In the further course of therapy heparin was adjusted so that the thrombin time was 2 to 4 times of the normal. The duration of fibrinolytic therapy was mostly between 3 and 6 days in acute and between 7 and 14 days in subacute DVT. Severe side effects were seen in 2 patients, who had a strong bleeding. One patient died of pulmonary embolism.Results: The 1-6 day old thromboses of the 19 patients could be dissolved completely in 7 patients (37%) and partially in 4 patients (21%); no amelioration in the phlebo- grams was found in 8 patients (42%). The 1-6 week old thromboses of the 55 patients could be dissolved completely in 9 patients (16%) and partially in 30 patients (55%); no amelioration in the phlebograms was found in 16 patients (29%).Conclusion: The standardized UK-heparin scheme with a medium dose 80.000 IU UK/h used by us proved to be effective in most patients with DVT.

FIBRINOLYTIC THERAPY WITH STREPTOKINASE AND UROKINASE IN DEEP VEIN THROMBOSIS

1987 ◽  
Author(s):  
G Trübestein ◽  
M Ludwig ◽  
M Wilgalis ◽  
R Trübestein ◽  
S Popov
Keyword(s):  
Deep Vein Thrombosis ◽  
Fibrinolytic Therapy ◽  
Vein Thrombosis ◽  
Complete Recanalisation ◽  
Group A ◽  
Acute Deep Vein Thrombosis ◽  
The Uk ◽  
Deep Vein ◽  
Heparin Dosage ◽  
Deep Vein Thromboses

336 patients with acute 1-6 day old, and subacute, 1-3 week old deep vein thrombosis were treated with streptokinase (SK) or urokinase (UK) up to April 1, 1985. 175 patients were included in the SK group, 161 patients in the UK group. A standardized SK-heparin and the standardized UK-heparin dosage scheme with 100.000 IU SK/h or 100.000 IU UK/ h were used. In patients with acute deep vein thrombosis a complete recanalisation could be achieved in 67% and a partial recanalisation in 25% with the standardized SK scheme; a complete recanalisation could be achieved in 46%, and a partial recanalisation in 30% with the standardized UK scheme.Since April 1, 1985 we use the ultra high SK dosage scheme, with an initial dose of 250.000 IU SK/h and a maintenance dose of 1.500.000 IU SK/h over.6 hours. So far 28 patients were treated in this way. The results show, that with an ultra high SK-dosage scheme a complete recanalisation could be achieved in 46% and a partial recanalisation in 25% in 1-6 day old deep vein thromboses. The results of both the SK schemes and the UK scheme are discussed in accordance with the haemostaseologica1 parameters.

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