- This study assessed test characteristics of two-point (common femoral and popliteal vein) lower extremity DVT ultrasound performed by emergency physicians using a 7.5-MHz linear probe, after a 10-minute training session. The study revealed a sensitivity of 100% (95% CI 92-100%) and specificity of 99.4% (95% CI 96-100%), (95% CI 92-100%), with the diagnostic radiology interpretation used as the criterion standard.
- Crisp JG, Lovato LM, Jang TB. Compression ultrasonography of the lower extremity with portable vascular ultrasonography can accurately detect deep venous thrombosis in the emergency department. Ann Emerg Med. 2010 Dec;56(6):601-10.
- This study assessed test characteristics of three-point (common femoral, superficial femoral and popliteal vein)lower extremity DVT ultrasound performed by emergency medicine faculty, residents, and mid-level providersusing a 14-MHz linear probe. The study revealed a sensitivity of 70% (95% CI 60-80%)and specificity of 89%(95% CI 83-94%), with the criterion standard consisting of both a positive DVT on whole leg venous ultrasonography through diagnostic radiology AND clinical decision to treat. Of note, the study identified a trend of residents reporting higher difficulty of the exam and decreased accuracy of the ultrasound.
- Kline JA, O’Malley PM, Tayal VS, Snead GR, Mitchell AM. Emergency clinician-performed compression ultrasonography for deep venous thrombosis of the lower extremity. Ann Emerg Med. 2008 Oct;52(4):437-45.
- This study aimed to assess the prevalence of DVT in locations proximal to the two-point ultrasound exams that exam the common femoral and popliteal veins. The study found that 6.3% of ED patients with suspected DVT had isolated thrombi in proximal veins and calls to question if ED investigation should include more than a two-point examination.
- Adhikari, S., Zeger, W., Thom, C., & Fields, J. M. (2015). Isolated deep venous thrombosis: Implications for 2-point compression ultrasonography of the lower extremity. Annals of Emergency Medicine, 66(3), 262–266. https://doi.org/10.1016/j.annemergmed.2014.10.032
- This review study assessed the work-up for upper extremity DVT and the pathway clinicians might consider. The recommended diagnostic work-up includes application of a clinical decision tool, D-Dimer and imaging including ultrasound. The study reported a systematic review of ultrasound that found a pooled sensitivity of 84% (95% CI 72-97%) and specificity of 94% (95% CI 86-100%) without compression, 97% (95% CI 90-100%) and 96% (95% CI 97-100%) with compression, and 91% (95% CI 85-97%) and 93% (95% CI 80-100%)for Doppler ultrasonography.
- Kraaijpoel, N., van Es, N., Porreca, E., Büller, H. R., & Di Nisio, M. (2017). The diagnostic management of upper extremity deep vein thrombosis: A review of the literature. Thrombosis Research, 156, 54–59. https://doi.org/10.1016/j.thromres.2017.05.035
- This study utilized a panel to review current guidelines for lower extremity ultrasound for DVT given the heterogeneity in published The consensus of this panel was a comprehensive duplex ultrasound utilizing Doppler from thigh to ankle at selected sites was superior than compression-only or limited examination.
- Needleman, L., Cronan, J. J., Lilly, M. P., Merli, G. J., Adhikari, S., Hertzberg, B. S., DeJong, M. R., Streiff, M. B., & Meissner, M. H. (2018). Ultrasound for lower extremity deep venous thrombosis. Circulation, 137(14), 1505–1515. https://doi.org/10.1161/circulationaha.117.030687
- This article aimed to discuss the anatomy of the lower extremity that may be viewed with ultrasound to rule out DVT and discuss other diagnoses if DVT is ruled out. The study divided the anatomy of the lower leg into 4 parts and provided differentials and relevant findings to consider when utilizing ultrasound.
- Useche, J. N., de Castro, A. M., Galvis, G. E., Mantilla, R. A., & Ariza, A. (2008). Use of us in the evaluation of patientswith symptoms of deep venous thrombosis of the lower extremities. RadioGraphics, 28(6), 1785–1797. https://doi.org/10.1148/rg.286085513
- This study aimed to assess if ultrasound could be utilized as a part of a work-up strategy combining the Wells-Score and D-dimer as part of the algorithm. Using a limited-compression approach, the study found ultrasound alone had a sensitivity of 91% (95% CI 70-98%) and specificity of 97% (95% CI 92-99%) and as part of the strategy would have decreased the time to diagnostic certainty to 5.0 hrs and decreased advanced imaging to 43% from 70%.
- Poley, R. A., Newbigging, J. L., & Sivilotti, M. L. A. (2014). Estimated effect of an integrated approach to suspected deep venous thrombosis using limited-compression ultrasound. Academic Emergency Medicine, 21(9), 971–980. https://doi.org/10.1111/acem.12459
- This study aimed to assess lower extremity DVT diagnosis via ultrasound by comparing Emergency Providers (EP) (residents and attending physicians) to the radiology department for reliability. The study found a range of 90-95% interrater reliability across four anatomical locations; however, the study suggests its results demonstrate insufficient levels of baseline training in EPs required to consistently diagnose DVT.
- Mulcare, M. R., Lee, R. W., Pologe, J. I., Clark, S., Borda, T., Sohn, Y., Sacco, D. L., & Riley, D. C. (2016). Interrater reliability of emergency physician-performed ultrasonography for diagnosing femoral, popliteal, and great saphenous vein thromboses compared to the Criterion Standard study by radiology. Journal of Clinical Ultrasound, 44(6), 360–367. https://doi.org/10.1002/jcu.22338
- This article aims to provide a basic overview with the role and execution of POCUS for DVT. The article discusses the anatomy of the lower extremity venous system, the approach to operating the ultrasound equipment for accurate diagnosis and guidance for how to scan the required anatomical regions.
- Shiloh, A. L., McPhee, C., Eisen, L., Koenig, S., & Millington, S. J. (2020). Better with ultrasound. Chest, 158(3), 1122–1127. https://doi.org/10.1016/j.chest.2020.01.038
- This article provides an overview of lower extremity POCUS for DVT in the context of a case where radiology performed DVT ultrasound was not available. The article discusses patient selection, ultrasound settings, venous anatomy, two-zone techniques, thrombus identification and common pitfalls.
- Barrosse-Antle, M. E., Patel, K. H., Kramer, J. A., & Baston, C. M. (2021). Point-of-care ultrasound for bedside diagnosis of lower extremity DVT. Chest, 160(5), 1853–1863. https://doi.org/10.1016/j.chest.2021.07.010
- This review article aimed to assess methodology and current technology, sensitivity and specificity, the role of D-Dimer and the time, resources and education required for POCUS for lower extremity DVT. The study concluded POCUS in the hands of a well-trained clinician is a reliable diagnostic tool and that universally accepted standardized training protocols are necessary.
- Varrias, D., Palaiodimos, L., Balasubramanian, P., Barrera, C., Nauka, P., Arfaras-Melainis, A., Zamora, C., Zavras, P., Napolitano, M., Gulani, P., Ntaios, G., Faillace, R., & Galen, B. (2021). The use of point-of-care ultrasound (Pocus) in the diagnosis of deep vein thrombosis. Journal of Clinical Medicine, 10(17), 3903. https://doi.org/10.3390/jcm10173903
- This study reviewed current evidence and guidelines for diagnostic tools and workup of upper extremity DVT. The study discussed the Constans score, a clinical probability assessment, D-Dimer testing, ultrasound and the ARMOUR algorithm and determined external validation of the algorithm should be pursued to standardize upper extremity DVT to the existing pathways for lower extremity DVT.
- Kraaijpoel, N., van Es, N., Porreca, E., Büller, H. R., & Di Nisio, M. (2017). The diagnostic management of upper extremity deep vein thrombosis: A review of the literature. Thrombosis Research, 156, 54–59. https://doi.org/10.1016/j.thromres.2017.05.035