title: Value of venous color flow duplex scan as initial screening test for geriatric inpatients with clinically suspected pulmonary embolism.
abstract: OBJECTIVE
  The contribution of lower extremity venous duplex scan to the diagnostic strategy for pulmonary embolism has been demonstrated by many authors. However, the positive diagnostic value of this noninvasive test in clinically suspected pulmonary embolism is not very high (10% - 18%). Since thromboembolic risks increase considerably in hospitalized patients with advanced age, this study aims to determine the importance of lower extremity venous color flow duplex scan in this particular subgroup of patients with clinically suspected pulmonary embolism. The effects of clinical presentation and risk factors on the results of duplex scan have been also studied.
  
  
  METHODS
  Between July 2007 and January 2010, 95 consecutive Lebanese geriatric (≥ 60 years of age) inpatients with clinically suspected pulmonary embolism assessed in an academic tertiary-care center for complete lower extremity venous color flow duplex scan were retrospectively reviewed. Age varied between 60 and 96 years (mean, 79.9 years). Forty patients were males and 55 females. Absence of compressibility was the most important criteria for detecting acute venous thrombosis.
  
  
  RESULTS
  Out of 95 patients, 33 patients (34.7%) were diagnosed with recent deep venous thrombosis of lower extremities (14 proximal and 19 distal) using complete venous ultrasound. Nine of these 33 patients (27.2%) had a history of venous thromboembolism and eleven (33.3%) presented with edema of lower extremities. A total of 28 patients (84.8%) with positive duplex scan had associated risk factors for venous thromboembolism.
  
  
  CONCLUSIONS
  Lower extremity venous color flow duplex scan appears to be a reasonable initial screening test in the diagnostic algorithm of pulmonary embolism in geriatric inpatients with clinically suspected pulmonary embolism. This is particularly true in patients with a history of venous thromboembolism, in patients with a clinical presentation suggesting venous thrombosis, in uremic patients and in patients with altered general and mental status who are not candidates for chest computed tomography.
authors.affiliation: Department of Vascular Surgery, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon. docrkdy@inco.com.lb
authors.forename: Raghid
authors.initials: R
authors.lastname: Kreidy
authors.forename: Elias
authors.initials: E
authors.lastname: Stephan
authors.forename: Pascale
authors.initials: P
authors.lastname: Salameh
authors.forename: Mirna
authors.initials: M
authors.lastname: Waked
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007861:Lebanon; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D018615:Ultrasonography, Doppler, Color; D014680:Veins / Q000000981:diagnostic imaging; D020246:Venous Thrombosis / Q000150:complications / Q000000981:diagnostic imaging*