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.
Lensing
A W
AW
Academic Medical Center, Amsterdam, The Netherlands.
Levi
M M
MM
Büller
H R
HR
Prandoni
P
P
Vigo
M
M
Agnelli
G
G
Lupatelli
L
L
Huisman
M V
MV
ten Cate
J W
JW
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