Improved selection criteria for ordering stat venous ultrasounds from the emergency department.
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.
Armstrong
P A
PA
Wright State University School of Medicine, Department of Surgery, Dayton, Ohio 45409, USA.
Peoples
J B
JB
Vitello
W A
WA
Lemmon
G W
GW
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*