Hospitalist-Operated Compression Ultrasonography: a Point-of-Care Ultrasound Study (HOCUS-POCUS).
hospitalists
thromboembolism
ultrasonography
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
30
04
2018
accepted:
20
04
2019
revised:
26
10
2018
pubmed:
8
8
2019
medline:
18
11
2020
entrez:
8
8
2019
Statut:
ppublish
Résumé
Venous thromboembolism includes deep vein thrombosis (DVT) and pulmonary embolism. Compression ultrasonography is the most common way to evaluate DVT and is typically performed by sonographers and interpreted by radiologists. Yet there is evidence that ultrasound examinations can be safely and accurately performed by clinicians at the bedside. To measure the operating characteristics of hospital medicine providers performing point-of-care ultrasound (POCUS) for evaluation of DVT. This is a prospective cohort study enrolling a convenience sample of patients. Hospital medicine providers performed POCUS for DVT and the results were compared with the corresponding formal vascular study (FVS) interpreted by radiologists. Hospitalized non-ICU patients at four tertiary care hospitals for whom a DVT ultrasound was ordered. The primary outcomes were the sensitivity, specificity, and predictive values of the POCUS compression ultrasound compared with a FVS. The secondary outcome was the elapsed time between order and the POCUS study compared with the time the FVS was ordered to when the formal radiology report was finalized. One hundred twenty-five limbs from 73 patients were scanned. The prevalence of DVT was 6.4% (8/125). The sensitivity of POCUS for DVT was 100% (95% CI 74-100%) and specificity was 95.8% (95% CI 91-98%) with a positive predictive value of 61.5% (95% CI 35-84%) and a negative predictive value of 100% (95% CI 98-100%). The median time from order to POCUS completion was 5.8 h versus 11.5 h median time from order until the radiology report was finalized (p = 0.001). Hospital medicine providers can perform compression-only POCUS for DVT on inpatients with accuracy similar to other specialties and settings, with results available sooner than radiology. The observed prevalence of DVT was lower than expected. POCUS may be reliable in excluding DVT but further study is required to determine how to incorporate a positive POCUS DVT result into clinical practice.
Sections du résumé
BACKGROUND
Venous thromboembolism includes deep vein thrombosis (DVT) and pulmonary embolism. Compression ultrasonography is the most common way to evaluate DVT and is typically performed by sonographers and interpreted by radiologists. Yet there is evidence that ultrasound examinations can be safely and accurately performed by clinicians at the bedside.
OBJECTIVE
To measure the operating characteristics of hospital medicine providers performing point-of-care ultrasound (POCUS) for evaluation of DVT.
DESIGN
This is a prospective cohort study enrolling a convenience sample of patients. Hospital medicine providers performed POCUS for DVT and the results were compared with the corresponding formal vascular study (FVS) interpreted by radiologists.
PARTICIPANTS
Hospitalized non-ICU patients at four tertiary care hospitals for whom a DVT ultrasound was ordered.
MAIN MEASURES
The primary outcomes were the sensitivity, specificity, and predictive values of the POCUS compression ultrasound compared with a FVS. The secondary outcome was the elapsed time between order and the POCUS study compared with the time the FVS was ordered to when the formal radiology report was finalized.
KEY RESULTS
One hundred twenty-five limbs from 73 patients were scanned. The prevalence of DVT was 6.4% (8/125). The sensitivity of POCUS for DVT was 100% (95% CI 74-100%) and specificity was 95.8% (95% CI 91-98%) with a positive predictive value of 61.5% (95% CI 35-84%) and a negative predictive value of 100% (95% CI 98-100%). The median time from order to POCUS completion was 5.8 h versus 11.5 h median time from order until the radiology report was finalized (p = 0.001).
CONCLUSION
Hospital medicine providers can perform compression-only POCUS for DVT on inpatients with accuracy similar to other specialties and settings, with results available sooner than radiology. The observed prevalence of DVT was lower than expected. POCUS may be reliable in excluding DVT but further study is required to determine how to incorporate a positive POCUS DVT result into clinical practice.
Identifiants
pubmed: 31388904
doi: 10.1007/s11606-019-05120-5
pii: 10.1007/s11606-019-05120-5
pmc: PMC6816719
doi:
Types de publication
Journal Article
Multicenter Study
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
2062-2067Références
JAMA. 2008 Oct 8;300(14):1653-9
pubmed: 18840838
Nat Rev Cardiol. 2015 Aug;12(8):464-74
pubmed: 26076949
BMC Med Imaging. 2005 Oct 03;5:6
pubmed: 16202135
J Thromb Haemost. 2009 Dec;7(12):2035-41
pubmed: 19817986
Thromb Haemost. 2013 Jan;109(1):137-45
pubmed: 23138420
Chest. 2011 Mar;139(3):538-542
pubmed: 21030490
Chest. 2012 Feb;141(2 Suppl):e351S-e418S
pubmed: 22315267
J Am Coll Cardiol. 2013 Aug 13;62(7):649-65
pubmed: 23876422
Blood. 2017 Jul 13;130(2):109-114
pubmed: 28483763
Ann Fam Med. 2017 Nov;15(6):535-539
pubmed: 29133492
Proc R Soc Lond A Math Phys Sci. 1946;186(1007):453-61
pubmed: 20998741
JAMA Intern Med. 2015 Jul;175(7):1112-7
pubmed: 25985219
Blood. 2015 Nov 19;126(21):2376-82
pubmed: 26585807
J Thromb Thrombolysis. 2016 Jan;41(1):3-14
pubmed: 26780736
J Thromb Thrombolysis. 2014 Apr;37(3):298-302
pubmed: 23722715
Chest. 2012 Feb;141(2 Suppl):e419S-e496S
pubmed: 22315268
J Grad Med Educ. 2013 Sep;5(3):493-7
pubmed: 24404316
Emerg Med J. 2003 Sep;20(5):453-8
pubmed: 12954688