Diagnosis of deep-vein thrombosis using an objective Doppler method.
OBJECTIVE
To determine the diagnostic criteria (phase I) and to assess the accuracy (phase II) of an objective Doppler-Valsalva pressure method as compared with contrast venography for the diagnosis of acute deep-leg-vein thrombosis in symptomatic outpatients.


METHODS
A two-phase prospective study in consecutive patients. Doppler ultrasound strip-chart recordings and venograms were independently analyzed by experienced observers.


METHODS
Referral-based medical clinics at university medical centers.


METHODS
One hundred and ten (phase I) and one hundred and fifty-five (phase II) patients who had clinically suspected venous thrombosis and were referred by their general practitioners were included.


METHODS
A normal Doppler test result was defined as a cyclic spontaneous signal (S-signal), a continuous S-signal with a Valsalva pressure of less than 6.5 mm Hg, or an absent S-signal with flow after cessation of the Valsalva maneuver. A continuous S-signal with a Valsalva pressure of 6.5 mm Hg or more or an absent S-signal without flow after cessation of the Valsalva maneuver were defined as abnormal test results. The accuracy indices for proximal vein thrombosis in phase II (155 patients; prevalence, 31%) were sensitivity, 91% (95% CI, 79% to 98%), and specificity, 99% (CI, 97% to 100%). All 3 patients with isolated calf-vein thrombosis had normal Doppler test results.


CONCLUSIONS
The objective Doppler method is an accurate, reproducible, and simple method for detection of venous thrombosis in symptomatic outpatients.
Academic Medical Center, Amsterdam, The Netherlands.
A W
AW
Lensing
M M
MM
Levi
H R
HR
Büller
P
P
Prandoni
M
M
Vigo
G
G
Agnelli
L
L
Lupatelli
M V
MV
Huisman
J W
JW
ten Cate
D000005:Abdomen / Q000502:physiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010690:Phlebography; D011237:Predictive Value of Tests; D011312:Pressure; D011446:Prospective Studies; D012039:Regional Blood Flow; D015203:Reproducibility of Results; D013924:Thrombophlebitis / Q000175:diagnosis*; D014160:Transducers, Pressure; D014463:Ultrasonography / Q000379:methods*; D014636:Valsalva Maneuver