title: Improved selection criteria for ordering stat venous ultrasounds from the emergency department.
abstract: BACKGROUND
  The accuracy and convenience of venous ultrasound (VU) to exclude deep vein thrombosis (DVT) has led to indiscriminate use and low positive yield rates.
  
  
  METHODS
  A total of 256 patients were referred from our emergency department (ED) for stat VU during a 2-year period (1995 to 1996). The VUs were interpreted as normal in 198 (77%). Positive findings were discovered in 58 (23%), with DVT accounting for 43 (17%). Retrospective multivariant analysis was used to identify predictive indicators.
  
  
  RESULTS
  Unilateral leg swelling/edema identified 36 of 40 (90%) patients with DVT and 8 of 10 (80%) with other thrombotic disorders (saphenous and/or chronic venous thrombosis). A history of leg pain with prior DVT or recent trauma < or =3 days' duration increased DVT duration to 98% (39 of 40). Using these criteria, a 47% charge reduction would have been recognized.
  
  
  CONCLUSIONS
  Improving ED screening criteria can safely increase yield rate and reduce charges with minimal loss of VU sensitivity.
authors.affiliation: Wright State University School of Medicine, Department of Surgery, Dayton, Ohio 45409, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Armstrong
authors.forename: J B
authors.initials: JB
authors.lastname: Peoples
authors.forename: W A
authors.initials: WA
authors.lastname: Vitello
authors.forename: G W
authors.initials: GW
authors.lastname: Lemmon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013924:Thrombophlebitis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D013997:Time Factors; D014463:Ultrasonography / Q000191:economics*; D018608:Ultrasonography, Doppler / Q000191:economics; D014680:Veins / Q000000981:diagnostic imaging*