Impact of point-of-care ultrasound on disposition time of patients presenting with lower extremity deep vein thrombosis, done by emergency physicians

Javad Seyedhosseini; Arash Fadavi; Elnaz Vahidi; Morteza Saeedi; Mehdi Momeni

doi:10.1016/j.tjem.2017.12.003

Javad Seyedhosseini¹, Arash Fadavi², Elnaz Vahidi¹, Morteza Saeedi³, Mehdi Momeni³

¹Tehran University of Medical Sciences, Shariati Hospital, Emergency Medicine Research Center, Iran
²Kermanshah University of Medical Sciences, Emergency Medicine Research Center, Iran
³Tehran University of Medical Sciences, Shariati Hospital, Emergency Medicine Department, Iran

Keywords: Ultrasonography, Deep vein thrombosis, Emergency physician, Radiologist, Disposition

Abstract

Background: Point-of-care venous compression ultrasound (VCU) is highly accurate in deep vein thrombosis (DVT) diagnosis; however, waiting to perform this exam by radiologists, may cause delay in patients' disposition.

Objective: To compare the effect of point-of-care VCU on patients' disposition time, done by emergency physician versus radiologists.

Methods: A total of 50 patients suspected of having lower extremity DVT, were randomized into 2 equal groups and they underwent a point-of-care VCU performed either by an emergency physician (emergency medicine (EM) group) or a radiologist (radiology group). The mean time of patients' disposition and management were compared between the two groups.

Results: The EM group consisted of 16 males and 9 females while the radiology group consisted of 13 males and 12 females. The median time elapsed from triage to performing ultrasonography and the median time elapsed from triage to final disposition were significantly lower in the EM group than those in the radiology group (50 min vs. 142 min, and 69 min vs. 260 min, respectively; p < .001). The final diagnosis was confirmed to be DVT in 14 patients (56%) in the EM group and in 17 patients (68%) in the radiology group (p = .38). There was no false positive or negative diagnosis.

Conclusions: Performing VCU in patients suspected of having DVT by a trained emergency physician could significantly reduce the time of patients' disposition in the emergency setting.