title: Venous duplex scanning for suspected deep vein thrombosis: results before and after elimination of after-hours studies.
abstract: OBJECTIVE
  A 24-hour venous duplex ultrasound (VDU) for suspected deep vein thrombosis (DVT) imposes significant resource burdens on a hospital. We hypothesize that termination of after-hours services increases empiric therapy without affecting clinical outcomes.
  
  
  METHODS
  A retrospective review of patients evaluated by the emergency department (ED) for suspected DVT in 2005 and 2007. Demographics, empiric treatment, and complications were compared using propensity scores and multivariate regression models.
  
  
  RESULTS
  In 2005 and 2007, 318 and 365 patients, respectively, had VDU after referral by the ED. In all, 49 (16%) tests during 2005 were after-hours, with 31 and 25 acute DVTs in 2005 and 2007, respectively. More patients received empiric treatment in 2007: 51 (14%) vs 26 ([8%]; P = .019) and tended to be more likely to have acute DVT: 7 (28%) vs 3 ([10%]; P = .08). We detected no complications from empiric anticoagulation and no difference in outcome. Estimated annual savings were $11 864.
  
  
  CONCLUSIONS
  Elimination of around-the-clock VDU can render substantial savings to hospitals without adverse consequence in the management of acute DVT.
authors.affiliation: Division of Vascular Surgery, Johns Hopkins Bayview Medical Center, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. gja10@jhmi.edu
authors.forename: George J
authors.initials: GJ
authors.lastname: Arnaoutakis
authors.forename: James
authors.initials: J
authors.lastname: Pirrucello
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Brooke
authors.forename: Thomas
authors.initials: T
authors.lastname: Reifsnyder
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000191:economics; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D015142:Baltimore; D016009:Chi-Square Distribution; D017046:Cost Savings; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D017721:Hospital Costs; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D057216:Propensity Score; D011787:Quality of Health Care / Q000191:economics; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000191:economics; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000191:economics / Q000628:therapy
chemical_list: D000925:Anticoagulants