Low accuracy of color Doppler ultrasound in the detection of proximal leg vein thrombosis in asymptomatic high-risk patients

B. L. Davidson, C. G. Elliott, A. W A Lensing, V. Cabanas, C. Chenault, D. Dall, D. R. Chandler, D. Drennan, M. Suchyta, R. J. Friedman, M. Goble, H. E. Groth, S. Hoff, J. Heit, A. Hofmann, L. Murdock, T. Hyers, J. Ohar, W. M. Johnson

Research output: Contribution to journalArticlepeer-review

217 Scopus citations

Abstract

Objective: To evaluate the ability of color Doppler ultrasound to detect proximal deep venous thrombosis (DVT) in asymptomatic high-risk patients who subsequently underwent contrast venography. Design: Prospective cohort study using blinded observers, with contrast venography as the comparison standard. Setting: Seven medical centers (university and community hospitals) participating in a clinical trial of low-molecular-weight heparin for prevention of DVT. Patients: A total of 385 consecutive patients undergoing elective unilateral hip or knee replacement. Measurements: Ten days after surgery or before hospital discharge (whichever occurred first), patients had bilateral color Doppler ultrasound examinations of the proximal veins of the lower extremities. Subsequently, a contrast venogram of the operated leg was obtained. Results: Color Doppler ultrasound studies and venograms were both evaluable in 319 of the 385 patients: Deep venous thrombosis was identified by contrast venography in 80 patients (prevalence, 25%; 95% CI, 20% to 30%) and involved the proximal veins in 21 patients (prevalence, 7%; CI, 4% to 10%). For proximal DVT, color Doppler ultrasound showed poor sensitivity (38%; CI, 18% to 62%), moderately good specificity (92%; CI, 89% to 95%), and a poor positive predictive value for this population (26%). Conclusion: Color Doppler ultrasound examinations are insensitive to proximal DVT in asymptomatic high-risk patients and should not be substituted for venography for identifying proximal DVT in such patients.

Original languageEnglish (US)
Pages (from-to)735-738
Number of pages4
JournalAnnals of Internal Medicine
Volume117
Issue number9
StatePublished - 1992
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine

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