Doppler ultrasound evaluation for lower extremity deep venous thrombosis in a community hospital.

The accuracy of Doppler examination for lower extremity deep venous thrombosis in a community hospital vascular laboratory was determined by comparing the Doppler results with venograms of 97 limbs in 90 patients. There were 47 limbs with a normal Doppler study, 46 abnormal (consistent with deep venous thrombosis) and 4 with an equivocal study. The overall accuracy was 95%. Both the sensitivity and specificity were 94% when equivocal studies were considered abnormal. Based on these results, we recommend venography or repeat Doppler examination for patients with a normal Doppler study only if the clinical findings are strongly suggestive of deep venous thrombosis. Patients with an abnormal Doppler examination and clinical findings consistent with deep venous thrombosis can be treated for deep venous thrombosis, with a high degree of confidence in the diagnosis, without venography. Patients with equivocal Doppler examinations are advised to have a venogram. While our results are equal to the best reports from research-oriented university vascular laboratories it should not be assumed that they can be readily reproduced in other settings. The technologists performing these studies should be highly skilled, experienced and preferably board certified. Internal quality control of any testing facility is necessary to assure accurate and reliable Doppler ultrasonic results prior to recommending treatment of deep venous thrombosis based on Doppler ultrasound without venography.