Clinical evaluation of suspected deep vein thrombosis guides the decision to anticoagulate prophylactically but does not impact the decision to perform after hours duplex venous scanning or increase its yield

Objective The utility of after-hours duplex venous scanning (DVS) for suspected deep vein thrombosis (DVT) in emergency department (ED) patients has been debated. Availability of safe prophylactic low molecular weight heparin, cost containment efforts, and retention of scarce sonographers have to be...

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Published in:Journal of vascular surgery 2013-06, Vol.57 (6), p.1597-1602
Main Authors: Go, Michael R., MD, Kiser, Dennis, RVT, Wald, Patrick, MS, Haurani, Mounir J., MD, Moseley, Mark, MD, MHA, Satiani, Bhagwan, MD, MBA
Format: Article
Language:English
Subjects:
After-Hours Care
Anticoagulants - therapeutic use
Emergencies
Humans
Retrospective Studies
Surgery
Ultrasonography, Interventional
Venous Thrombosis - diagnosis
Venous Thrombosis - prevention & control
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Summary:Objective The utility of after-hours duplex venous scanning (DVS) for suspected deep vein thrombosis (DVT) in emergency department (ED) patients has been debated. Availability of safe prophylactic low molecular weight heparin, cost containment efforts, and retention of scarce sonographers have to be balanced against 24/7 demand for services. We determined the incidence of DVT in DVS ordered after-hours, correlation between Wells' score and prophylactic anticoagulation as well as urgently performed DVS, and complications of delaying DVS until regular hours. Methods Records of all ED encounters between July 1, 2009 and June 30, 2010 associated with a DVS ordered after-hours were reviewed. The decisions to prophylactically anticoagulate and whether to perform DVS urgently or delayed until regular hours were at the discretion of the ED physician and a vascular surgeon. DVS findings, number of urgent and delayed studies, Wells' scores, D-dimers, and outcomes were recorded. Results DVT was found in 12% (22) of 181 DVS ordered after-hours. DVT was found in 19% of 42 DVS done urgently and in 10% of 139 DVS delayed an average 10 hours 17 minutes ( P  = NS). All patients had Wells' scores and 43 had D-dimers. Furthermore, 76% of patients with a Wells' score ≥3 had prophylactic anticoagulation whereas only 39% of patients with a Wells' score 
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2012.11.076