The clinical effectiveness of hand held Doppler examination for diagnosis of reflux in patients with varicose veins.
OBJECTIVE
To assess the accuracy of hand held Doppler (HHD) as a rapid screening test for selecting varicose vein patients for duplex imaging.


METHODS
Prospective single blind study of consecutive patients in a randomised trial.


METHODS
Use of hand held Doppler and duplex ultrasound scanners.


METHODS
One thousand two hundred and eighteen legs (943 patients) were examined by HHD and then duplex. HHD examiners recorded whether they would normally have requested duplex.


RESULTS
HHD results of one Clinical Assistant (166 limbs) were significantly poorer than all others and his results were excluded from analysis. Duplex would not have been requested in 645 of 1052 (62%) limbs. Among these HHD missed significant reflux in the long saphenous vein in 18 (3%) and the short saphenous in 25 (4%). Reasons for requesting duplex were popliteal fossa reflux (202); recurrent (94) or atypical (86) varicose veins; and possible previous thrombosis (67). Differences were observed between staff and units in requests for duplex; and in thoroughness and style of duplex reporting.


CONCLUSIONS
Selective use of HHD can avoid duplex imaging for many patients, with a low failure rate for detecting correctable venous reflux. Observed variations between individuals and units in results of HHD and duplex imaging have implications for the increasing use of duplex by clinicians.
Campbell
W B
WB
Royal Devon and Exeter Hospital, Exeter, UK. bruce.campbell@nice.nhs.uk
Niblett
P G
PG
Peters
A S
AS
MacIntyre
J B
JB
Sherriff
S
S
Palfreyman
S
S
Michaels
J A
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001810:Blood Volume / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012501:Saphenous Vein / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012720:Severity of Illness Index; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*; D014648:Varicose Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology