General Practitioner–Performed Compression Ultrasonography for Diagnosis of Deep Vein Thrombosis of the Leg: A Multicenter, Prospective Cohort Study

Nicola Mumoli; Josè Vitale; Matteo Giorgi-Pierfranceschi; Silvia Sabatini; Renato Tulino; Marco Cei; Eugenio Bucherini; Carlo Bova; Daniela Mastroiacovo; Alberto Camaiti; Gerardo Palmiero; Luca Puccetti; Francesco Dentali

doi:10.1370/afm.2109

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Figure 1
Patient screening and study inclusion.
VTE=venous thromboembolism

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Table 1

Patient Demographic and Clinical Characteristics (N = 1,107)

Characteristics	DVT (n=200)	No DVT (n=907)
Age, mean (SD), [range], y	63.6 (±15.2) [20–101]	63.8 (±14.9) [19–98]
Men, No. (%)	104 (52)	587 (53)
Site of DVT
Femoral vein, No. (%)	104 (52)	n/a
Popliteal vein, No. (%)	152 (76)	n/a
Both, No. (%)	56 (28)	n/a

DVT=deep vein thrombosis; n/a=not applicable.

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Table 2

Diagnostic Performance of General Practitioner–Performed Compression US for Proximal DVT

DVT Site	Sensitivity, % (95% CI)	Specificity, % (95% CI)	PPV, % (95% CI)	NPV, % (95% CI)	Accuracy, % (95% CI)	Cohen κ, % (95% CI)
Overall	90.0 (88.2–91.8)	97.1 (96.2–98.1)	87.4 (85.4–89.3)	97.8 (96.9–98.6)	95.8 (94.7–97.0)	0.86 (0.84–0.88)
Femoral	95.2 (93.9–96.5)	98.8 (98.2–99.4)	89.2 (87.4–91.0)	99.5 (99.1–99.9)	98.5 (97.7–99.2)	0.91 (0.89–0.93)
Popliteal	89.5 (87.7–91-3)	98.4 (97.7–99.2)	90.1 (88.3–91.8)	98.3 (97.6–99.1)	97.2 (96.2–98.2)	0.88 (0.86–0.90)
Both	98.7 (98.0–99.3)	100 (99.9–100)	100 (99.9–100)	99.9 (99.7–100)	99.9 (99.7–100)	0.99 (0.98–0.99)

DVT = deep vein thrombosis; NPV = negative predictive value; PPV = positive predictive value; US = ultrasound.
Note: Diagnosis of physician expert in vascular US was the reference test.

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The Article in Brief

General Practitioner-Performed Compression Ultrasonography for Diagnosis of Deep Vein Thrombosis of the Leg: A Multicenter, Prospective Cohort Study

Nicola Mumoli , and colleagues

Background Compression ultrasonography has many advantages as a tool to identify deep-vein thrombosis. This study assesses the diagnostic accuracy of compression ultrasonography performed by general practitioners who receive vascular ultrasound training in diagnosing suspected deep vein thrombosis of the lower limbs.

What This Study Found General practitioners trained in compression ultrasonography have excellent accuracy and agreement in diagnosing symptomatic proximal deep vein thrombosis. In a study of more than 1,000 outpatients with clinically suspected deep vein thrombosis, diagnosis was performed by physician experts in vascular ultrasonography and GPs trained in the technique. Expert physicians diagnosed deep vein thrombosis in 200 patients, corresponding to an overall prevalence of 18 percent. Compression ultrasonography performed by GPs had sensitivity of 90 percent and specificity of 97 percent with diagnostic accuracy for deep vein thrombosis of 96 percent. Because sensitivity achieved by GPs appeared suboptimal, the authors call for future studies to evaluate the implementation of proper training strategies to maximize skill.

Implications

The authors suggest that more rapid diagnosis, directly obtained by GPs in primary care, could improve appropriate management of deep vein thrombosis and help address the growing need for professionals trained in compression ultrasonography.