Is colour Doppler ultrasound a sensitive screening method in diagnosing deep vein thrombosis after hip surgery?
Patients under going orthopedic surgery are at high risk of developing deep vein thrombosis. One hundred and thirty-eight consecutive patients undergoing total hip replacement or hip fracture surgery were included in this study. They were surveilled with colour Doppler ultrasound (CDU) and bilateral ascending contrast phlebography. The prevalence of proximal and distal DVT in this study was 5.8% and 20.3% respectively. CDU has a satisfactory sensitivity in patients with symptomatic deep vein thrombosis, especially in the proximal region. These results could not be confirmed in the present study of asymptomatic patients. The sensitivity was 62.5% (95% confidence interval: C.I. 24-91%) and the specificity 99.6% (C.I. 98-100%) for proximal DVT; 53.6% (C.I. 34-73%) and 98% (C.I. 96-99%) respectively for distal thrombi. the overall sensitivity was 58.1% (C.I. 39-75%) and the specificity 98% (C.I. 96-99%). The positive predictive value was 83.3% (C.I. 36-99%) and 75% (C.I. 51-91%) for proximal and distal DVT respectively. The negative predictive value was 98.9% (C.I. 98-100%) and 94.9% (C.I. 92-98%) for proximal and distal DVT respectively. The results of this study showed that even with a highly specialised and experienced investigator the sensitivity of CDU was too low to make it suitable for screening purposes in a high risk surgical population.
Magnusson
M
M
Department of Clinical Physiology, Ostra Hospital, Göteborg, Sweden.
Eriksson
B I
BI
Kälebo
P
P
Sivertsson
R
R
D000925:Anticoagulants / Q000627:therapeutic use; D017985:Dalteparin / Q000627:therapeutic use; D003911:Dextrans / Q000627:therapeutic use; D006620:Hip Fractures / Q000601:surgery*; D006622:Hip Prosthesis; D024764:Hirudin Therapy; D006629:Hirudins / Q000031:analogs & derivatives; D006801:Humans; D015994:Incidence; D010690:Phlebography; D011182:Postoperative Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011994:Recombinant Proteins / Q000627:therapeutic use; D012306:Risk; D012680:Sensitivity and Specificity; D013924:Thrombophlebitis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D018615:Ultrasonography, Doppler, Color
D000925:Anticoagulants; D003911:Dextrans; D006629:Hirudins; D011994:Recombinant Proteins; D017985:Dalteparin; C060225:desirudin