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...

Full description

Saved in:
Bibliographic Details
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
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c451t-3f62ac4bde16f1ec6f0131d289dc1b4997ba440848fcfe9af33ce1f53c883f2f3
cites cdi_FETCH-LOGICAL-c451t-3f62ac4bde16f1ec6f0131d289dc1b4997ba440848fcfe9af33ce1f53c883f2f3
container_end_page 1602
container_issue 6
container_start_page 1597
container_title Journal of vascular surgery
container_volume 57
creator Go, Michael R., MD
Kiser, Dennis, RVT
Wald, Patrick, MS
Haurani, Mounir J., MD
Moseley, Mark, MD, MHA
Satiani, Bhagwan, MD, MBA
description 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 
doi_str_mv 10.1016/j.jvs.2012.11.076
format article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1357495068</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0741521412025967</els_id><sourcerecordid>1357495068</sourcerecordid><originalsourceid>FETCH-LOGICAL-c451t-3f62ac4bde16f1ec6f0131d289dc1b4997ba440848fcfe9af33ce1f53c883f2f3</originalsourceid><addsrcrecordid>eNp9UsuqFDEQbUTxjlc_wI1k6WbaVPqNIMjgCy64UNchnVRmMqaTNkkPd_7STzLNjC4UXAWqzjmpqnOK4jnQEii0r47l8RRLRoGVACXt2gfFBujQbdueDg-LDe1q2DYM6pviSYxHSgGavntc3LCqGhpGh03xc2eNM1JYgidhF5GMd8RrEpc4o0yoiEKcyQmNI-kQ_DT6aCLZL0ZhzBXMfWniykqeCJeM9GK_WJGQzMHPh7MVMq0f2DMZl0SUzzznEzHTnDv_SMwYtA8TETphIAe_hEjUMlu8z0M4v0QSpXDOuD3xgRgnA4qIxKRIzgatelo80sJGfHZ9b4tv79993X3c3n3-8Gn39m4r6wbSttItE7IeFUKrAWWrKVSgWD8oCWM9DN0o6pr2da-lxkHoqpIIuqlk31ea6eq2eHnRzVv-WDAmPpko0VrhME_JoWq6emho22coXKAy-BgDaj4HM4lw5kD5aiQ_8mwkX43kADwbmTkvrvLLOKH6w_jtXAa8vgAwL3kyGHiUBp1EZUI2jitv_iv_5i-2vObgO54xHvPZXb4eBx4Zp_zLmqQ1SMAoa4a2q34BYkfKfw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1357495068</pqid></control><display><type>article</type><title>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</title><source>BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS</source><creator>Go, Michael R., MD ; Kiser, Dennis, RVT ; Wald, Patrick, MS ; Haurani, Mounir J., MD ; Moseley, Mark, MD, MHA ; Satiani, Bhagwan, MD, MBA</creator><creatorcontrib>Go, Michael R., MD ; Kiser, Dennis, RVT ; Wald, Patrick, MS ; Haurani, Mounir J., MD ; Moseley, Mark, MD, MHA ; Satiani, Bhagwan, MD, MBA</creatorcontrib><description>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 &lt;3 had prophylactic anticoagulation ( P  = .0001). In contrast, 36% of patients with a Wells' score ≥3 had urgent DVS and 20% of patients with a Wells' score &lt;3 had urgent DVS ( P  = NS). Prophylactic anticoagulation was given to 86% of patients eventually found to have DVT vs 40% of patients eventually found to have no DVT ( P  &lt; .0001). There were no pulmonary emboli or bleeding complications. Conclusions The incidence of DVT in ED patients who had urgent after-hours DVS was no different than in those whose DVS was delayed until regular hours. High pretest probability can be achieved with clinical evaluation prior to DVS, and this guided the decision to prophylactically anticoagulate but did not impact the decision to perform urgent DVS. Most patients eventually found to have DVT did receive prophylactic anticoagulation, and delay of DVS did not result in complications. We believe that most patients in whom there is high clinical suspicion for DVT can safely get prophylactic anticoagulation and delayed DVS. Patients in whom there is low clinical suspicion should not get urgent DVS.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2012.11.076</identifier><identifier>PMID: 23395209</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>After-Hours Care ; Anticoagulants - therapeutic use ; Emergencies ; Humans ; Retrospective Studies ; Surgery ; Ultrasonography, Interventional ; Venous Thrombosis - diagnosis ; Venous Thrombosis - prevention &amp; control</subject><ispartof>Journal of vascular surgery, 2013-06, Vol.57 (6), p.1597-1602</ispartof><rights>Society for Vascular Surgery</rights><rights>2013 Society for Vascular Surgery</rights><rights>Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-3f62ac4bde16f1ec6f0131d289dc1b4997ba440848fcfe9af33ce1f53c883f2f3</citedby><cites>FETCH-LOGICAL-c451t-3f62ac4bde16f1ec6f0131d289dc1b4997ba440848fcfe9af33ce1f53c883f2f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27898,27899</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23395209$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Go, Michael R., MD</creatorcontrib><creatorcontrib>Kiser, Dennis, RVT</creatorcontrib><creatorcontrib>Wald, Patrick, MS</creatorcontrib><creatorcontrib>Haurani, Mounir J., MD</creatorcontrib><creatorcontrib>Moseley, Mark, MD, MHA</creatorcontrib><creatorcontrib>Satiani, Bhagwan, MD, MBA</creatorcontrib><title>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</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>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 &lt;3 had prophylactic anticoagulation ( P  = .0001). In contrast, 36% of patients with a Wells' score ≥3 had urgent DVS and 20% of patients with a Wells' score &lt;3 had urgent DVS ( P  = NS). Prophylactic anticoagulation was given to 86% of patients eventually found to have DVT vs 40% of patients eventually found to have no DVT ( P  &lt; .0001). There were no pulmonary emboli or bleeding complications. Conclusions The incidence of DVT in ED patients who had urgent after-hours DVS was no different than in those whose DVS was delayed until regular hours. High pretest probability can be achieved with clinical evaluation prior to DVS, and this guided the decision to prophylactically anticoagulate but did not impact the decision to perform urgent DVS. Most patients eventually found to have DVT did receive prophylactic anticoagulation, and delay of DVS did not result in complications. We believe that most patients in whom there is high clinical suspicion for DVT can safely get prophylactic anticoagulation and delayed DVS. Patients in whom there is low clinical suspicion should not get urgent DVS.</description><subject>After-Hours Care</subject><subject>Anticoagulants - therapeutic use</subject><subject>Emergencies</subject><subject>Humans</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Ultrasonography, Interventional</subject><subject>Venous Thrombosis - diagnosis</subject><subject>Venous Thrombosis - prevention &amp; control</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><recordid>eNp9UsuqFDEQbUTxjlc_wI1k6WbaVPqNIMjgCy64UNchnVRmMqaTNkkPd_7STzLNjC4UXAWqzjmpqnOK4jnQEii0r47l8RRLRoGVACXt2gfFBujQbdueDg-LDe1q2DYM6pviSYxHSgGavntc3LCqGhpGh03xc2eNM1JYgidhF5GMd8RrEpc4o0yoiEKcyQmNI-kQ_DT6aCLZL0ZhzBXMfWniykqeCJeM9GK_WJGQzMHPh7MVMq0f2DMZl0SUzzznEzHTnDv_SMwYtA8TETphIAe_hEjUMlu8z0M4v0QSpXDOuD3xgRgnA4qIxKRIzgatelo80sJGfHZ9b4tv79993X3c3n3-8Gn39m4r6wbSttItE7IeFUKrAWWrKVSgWD8oCWM9DN0o6pr2da-lxkHoqpIIuqlk31ea6eq2eHnRzVv-WDAmPpko0VrhME_JoWq6emho22coXKAy-BgDaj4HM4lw5kD5aiQ_8mwkX43kADwbmTkvrvLLOKH6w_jtXAa8vgAwL3kyGHiUBp1EZUI2jitv_iv_5i-2vObgO54xHvPZXb4eBx4Zp_zLmqQ1SMAoa4a2q34BYkfKfw</recordid><startdate>20130601</startdate><enddate>20130601</enddate><creator>Go, Michael R., MD</creator><creator>Kiser, Dennis, RVT</creator><creator>Wald, Patrick, MS</creator><creator>Haurani, Mounir J., MD</creator><creator>Moseley, Mark, MD, MHA</creator><creator>Satiani, Bhagwan, MD, MBA</creator><general>Mosby, Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130601</creationdate><title>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</title><author>Go, Michael R., MD ; Kiser, Dennis, RVT ; Wald, Patrick, MS ; Haurani, Mounir J., MD ; Moseley, Mark, MD, MHA ; Satiani, Bhagwan, MD, MBA</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-3f62ac4bde16f1ec6f0131d289dc1b4997ba440848fcfe9af33ce1f53c883f2f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>After-Hours Care</topic><topic>Anticoagulants - therapeutic use</topic><topic>Emergencies</topic><topic>Humans</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Ultrasonography, Interventional</topic><topic>Venous Thrombosis - diagnosis</topic><topic>Venous Thrombosis - prevention &amp; control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Go, Michael R., MD</creatorcontrib><creatorcontrib>Kiser, Dennis, RVT</creatorcontrib><creatorcontrib>Wald, Patrick, MS</creatorcontrib><creatorcontrib>Haurani, Mounir J., MD</creatorcontrib><creatorcontrib>Moseley, Mark, MD, MHA</creatorcontrib><creatorcontrib>Satiani, Bhagwan, MD, MBA</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Go, Michael R., MD</au><au>Kiser, Dennis, RVT</au><au>Wald, Patrick, MS</au><au>Haurani, Mounir J., MD</au><au>Moseley, Mark, MD, MHA</au><au>Satiani, Bhagwan, MD, MBA</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2013-06-01</date><risdate>2013</risdate><volume>57</volume><issue>6</issue><spage>1597</spage><epage>1602</epage><pages>1597-1602</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>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 &lt;3 had prophylactic anticoagulation ( P  = .0001). In contrast, 36% of patients with a Wells' score ≥3 had urgent DVS and 20% of patients with a Wells' score &lt;3 had urgent DVS ( P  = NS). Prophylactic anticoagulation was given to 86% of patients eventually found to have DVT vs 40% of patients eventually found to have no DVT ( P  &lt; .0001). There were no pulmonary emboli or bleeding complications. Conclusions The incidence of DVT in ED patients who had urgent after-hours DVS was no different than in those whose DVS was delayed until regular hours. High pretest probability can be achieved with clinical evaluation prior to DVS, and this guided the decision to prophylactically anticoagulate but did not impact the decision to perform urgent DVS. Most patients eventually found to have DVT did receive prophylactic anticoagulation, and delay of DVS did not result in complications. We believe that most patients in whom there is high clinical suspicion for DVT can safely get prophylactic anticoagulation and delayed DVS. Patients in whom there is low clinical suspicion should not get urgent DVS.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>23395209</pmid><doi>10.1016/j.jvs.2012.11.076</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0741-5214
ispartof Journal of vascular surgery, 2013-06, Vol.57 (6), p.1597-1602
issn 0741-5214
1097-6809
language eng
recordid cdi_proquest_miscellaneous_1357495068
source BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS
subjects After-Hours Care
Anticoagulants - therapeutic use
Emergencies
Humans
Retrospective Studies
Surgery
Ultrasonography, Interventional
Venous Thrombosis - diagnosis
Venous Thrombosis - prevention & control
title 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
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-03-05T02%3A39%3A01IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Clinical%20evaluation%20of%20suspected%20deep%20vein%20thrombosis%20guides%20the%20decision%20to%20anticoagulate%20prophylactically%20but%20does%20not%20impact%20the%20decision%20to%20perform%20after%20hours%20duplex%20venous%20scanning%20or%20increase%20its%20yield&rft.jtitle=Journal%20of%20vascular%20surgery&rft.au=Go,%20Michael%20R.,%20MD&rft.date=2013-06-01&rft.volume=57&rft.issue=6&rft.spage=1597&rft.epage=1602&rft.pages=1597-1602&rft.issn=0741-5214&rft.eissn=1097-6809&rft_id=info:doi/10.1016/j.jvs.2012.11.076&rft_dat=%3Cproquest_cross%3E1357495068%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c451t-3f62ac4bde16f1ec6f0131d289dc1b4997ba440848fcfe9af33ce1f53c883f2f3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1357495068&rft_id=info:pmid/23395209&rfr_iscdi=true