title: Interrater reliability of emergency physician-performed ultrasonography for diagnosing femoral, popliteal, and great saphenous vein thromboses compared to the criterion standard study by radiology.
abstract: OBJECTIVE
  To assess the interrater reliability and test characteristics of lower limb sonographic examination for the diagnosis of deep venous and proximal great saphenous vein thrombosis when performed by Emergency Physicians (EPs) as compared to that by the Department of Radiology (Radiology). The secondary objective was to assess the effects of patient body mass index and EP satisfaction with bedside ultrasound on sensitivity and specificity.
  
  
  METHODS
  A prospective study was conducted for patients with clinical suspicion for lower extremity thrombus. EPs evaluated for venous thrombosis in the common femoral vein, femoral vein of the thigh, popliteal vein, and proximal great saphenous vein. Subsequently, all patients received ultrasounds by Radiology, the criterion standard.
  
  
  RESULTS
  One hundred ninety-seven patients (257 individual legs) were evaluated. There was 90-95% agreement between EP and Radiology, moderate kappa agreement for common femoral vein, and femoral vein of the thigh and fair kappa agreement for great saphenous vein and popliteal vein. The sensitivity and specificity of EP ultrasounds compared with criterion standard were lower than previously reported. There was no trend in patient body mass index or provider satisfaction influencing the test characteristics.
  
  
  CONCLUSIONS
  Our study suggests that point-of-care sonography should not replace Radiology-performed scans. The required amount of training for EPs to be competent in this examination needs further investigation. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:360-367, 2016.
authors.affiliation: Division of Emergency Medicine, Weill Cornell Medical College, New York, New York.|Emergency Medicine Residency, New York-Presbyterian Hospital, New York, New York.
authors.forename: Mary R
authors.initials: MR
authors.lastname: Mulcare
authors.affiliation: Division of Emergency Medicine, Columbia University Medical Center, New York, New York.|Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Randall W
authors.initials: RW
authors.lastname: Lee
authors.affiliation: Division of Emergency Medicine, Columbia University Medical Center, New York, New York.|Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Jonas I
authors.initials: JI
authors.lastname: Pologe
authors.affiliation: Division of Emergency Medicine, Weill Cornell Medical College, New York, New York.|Emergency Medicine Residency, New York-Presbyterian Hospital, New York, New York.
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.affiliation: Department of Family Medicine, The Brooklyn Hospital Center, Brooklyn, New York.
authors.forename: Tomas
authors.initials: T
authors.lastname: Borda
authors.affiliation: Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Gyeonggi-do, South Korea.
authors.forename: Youdong
authors.initials: Y
authors.lastname: Sohn
authors.affiliation: Emergency Medicine Residency, New York-Presbyterian Hospital, New York, New York.|Division of Emergency Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Dana L
authors.initials: DL
authors.lastname: Sacco
authors.affiliation: Emergency Medicine Residency, New York-Presbyterian Hospital, New York, New York.|Division of Emergency Medicine, Columbia University Medical Center, New York, New York.
authors.forename: David C
authors.initials: DC
authors.lastname: Riley
mesh_terms: D000328:Adult; D000368:Aged; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging*; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011152:Popliteal Vein / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D000072177:Radiologists; D011872:Radiology Department, Hospital / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012501:Saphenous Vein / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging*
keywords: deep venous thrombosis; emergency medicine; great saphenous vein; radiology; sonographic