Randomized prospective study comparing routine versus selective use of sonography of the complete calf in patients with suspected deep venous thrombosis.
OBJECTIVE
We compared patient outcomes using two protocols: one routinely and the other selectively evaluating the calves completely during sonographic assessment of the lower extremities in patients with suspected deep venous thrombosis.


METHODS
In this randomized prospective study, patients were assigned to two groups. In one group, the deep calf veins were routinely evaluated in their entirety, and in the other group the calf was not evaluated unless the patient had symptoms or physical signs in the calf, in which case only the areas of symptoms or physical signs were evaluated. Patients were followed up for 3 months by medical record review, physician surveys, and telephone calls. An adverse outcome was a propagated deep venous thrombosis into the thigh or a pulmonary embolus. Examination times were recorded when possible.


RESULTS
Of the 235 patients in the group in which the deep calf veins were routinely evaluated, we saw no adverse outcomes (0.0%; 97.5% one-sided confidence interval [CI], 0.6-1.6%). Of the 261 patients in the group in which the calf was only evaluated if there were signs or symptoms, we saw two adverse outcomes (0.8%; 95% CI, 0.1-2.7%).


CONCLUSIONS
We found no significant difference in adverse outcomes in patients undergoing a protocol in which the deep calf veins were routinely evaluated or a protocol in which the calf was evaluated only if physical signs or symptoms were present.
Gottlieb
Ronald H
RH
Department of Radiology, University of Rochester Medical Center, 601 Elmwood Ave., Box 648, Rochester, NY 14642, USA.
Voci
Susan L
SL
Syed
Labib
L
Shyu
Chandler
C
Fultz
Patrick J
PJ
Rubens
Deborah J
DJ
Strang
John G
JG
Carson
Nancy
N
DiGrazio
William J
WJ
Francis
Charles W
CW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000209:etiology; D012307:Risk Factors; D018616:Ultrasonography, Doppler, Duplex / Q000009:adverse effects / Q000379:methods*; D014680:Veins / Q000000981:diagnostic imaging; D020246:Venous Thrombosis / Q000000981:diagnostic imaging*