PURPOSE: The reliability of clinical signs and the physical examination in the evaluation of deep venous thrombosis (DVT) in the critically ill is unknown. The purpose of this study was to determine the diagnostic properties of clinical examination for signs of DVT in a cohort of medical-surgical intensive care unit (ICU) patients using screening compression ultrasonography as a reference standard. MATERIALS AND METHODS: We prospectively included patients older than 18 years with an expected length of ICU stay of more than 72 hours. Patients underwent bilateral lower limb screening compression ultrasound twice weekly and structured physical examination twice weekly by 2 independent trained research coordinators blinded to the ultrasonography results. We classified patients according to 2 methods: method 1, a DVT Risk Stratification System of 3 categories and method 2, a DVT Risk Score, both of which use the history and physical examination to stratify patients for their risk of DVT. RESULTS: We included 239 patients in our study, 32 of whom had DVT based on the results of their compression ultrasound. We excluded 7 patients with DVT on ICU admission and 2 who did not undergo any structured examinations. We matched controls with cases (9:1) based on duration of ICU stay. Cases and controls were then allocated to low, moderate, and high risk strata for DVT. Using method 1, the area under the receiver operating characteristic curve (AUC) was 0.57 (95% CI, 0.33-0.78, P = .01). Using method 2, the AUC was 0.59 (95% CI, 0.42-0.75, P = .02). An AUC of 1.0 indicates an ideal test, and AUC of 0.50 indicates a test with no diagnostic utility. CONCLUSIONS: The history and physical examination for DVT are not useful in detecting lower limb DVT in the ICU.
PURPOSE: The reliability of clinical signs and the physical examination in the evaluation of deep venous thrombosis (DVT) in the critically ill is unknown. The purpose of this study was to determine the diagnostic properties of clinical examination for signs of DVT in a cohort of medical-surgical intensive care unit (ICU) patients using screening compression ultrasonography as a reference standard. MATERIALS AND METHODS: We prospectively included patients older than 18 years with an expected length of ICU stay of more than 72 hours. Patients underwent bilateral lower limb screening compression ultrasound twice weekly and structured physical examination twice weekly by 2 independent trained research coordinators blinded to the ultrasonography results. We classified patients according to 2 methods: method 1, a DVT Risk Stratification System of 3 categories and method 2, a DVT Risk Score, both of which use the history and physical examination to stratify patients for their risk of DVT. RESULTS: We included 239 patients in our study, 32 of whom had DVT based on the results of their compression ultrasound. We excluded 7 patients with DVT on ICU admission and 2 who did not undergo any structured examinations. We matched controls with cases (9:1) based on duration of ICU stay. Cases and controls were then allocated to low, moderate, and high risk strata for DVT. Using method 1, the area under the receiver operating characteristic curve (AUC) was 0.57 (95% CI, 0.33-0.78, P = .01). Using method 2, the AUC was 0.59 (95% CI, 0.42-0.75, P = .02). An AUC of 1.0 indicates an ideal test, and AUC of 0.50 indicates a test with no diagnostic utility. CONCLUSIONS: The history and physical examination for DVT are not useful in detecting lower limb DVT in the ICU.
Authors: Ena Gupta; Furqan S Siddiqi; Ryan Kunjal; Muhammad Faisal; Farah Al-Saffar; Abubakr A Bajwa; Lisa M Jones; Vandana Seeram; James D Cury; Adil Shujaat Journal: J Thromb Thrombolysis Date: 2017-10 Impact factor: 2.300
Authors: Giorgio Carrabba; Marco Riva; Valeria Conte; Andrea Di Cristofori; Manuela Caroli; Marco Locatelli; Massimo Castellani; Paolo Bucciarelli; Andrea Artoni; Nino Stocchetti; Ida Martinelli; Paolo Rampini Journal: J Neurooncol Date: 2018-03-02 Impact factor: 4.130
Authors: Yaseen M Arabi; Karen E A Burns; Sami J Alsolamy; Mohammed S Alshahrani; Fahad M Al-Hameed; Zia Arshad; Mohammed Almaani; Hassan Hawa; Yasser Mandourah; Ghaleb A Almekhlafi; Abdulsalam Al Aithan; Imran Khalid; Jalal Rifai; Gulam Rasool; Sheryl Ann I Abdukahil; Jesna Jose; Lara Y Afesh; Abdulaziz Al-Dawood Journal: Intensive Care Med Date: 2020-02-24 Impact factor: 17.440
Authors: Robert A Fowler; Nicole Mittmann; William H Geerts; Diane Heels-Ansdell; Michael K Gould; Gordon Guyatt; Murray Krahn; Simon Finfer; Ruxandra Pinto; Brian Chan; Orges Ormanidhi; Yaseen Arabi; Ismael Qushmaq; Marcelo G Rocha; Peter Dodek; Lauralyn McIntyre; Richard Hall; Niall D Ferguson; Sangeeta Mehta; John C Marshall; Christopher James Doig; John Muscedere; Michael J Jacka; James R Klinger; Nicholas Vlahakis; Neil Orford; Ian Seppelt; Yoanna K Skrobik; Sachin Sud; John F Cade; Jamie Cooper; Deborah Cook Journal: Trials Date: 2014-12-20 Impact factor: 2.279