A Prospective Study of a Focused, Surgeon-Performed Ultrasound Examination for the Detection of Occult Common Femoral Vein Thrombosis in Critically Ill Patients

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Hypothesis A focused, surgeon-performed ultrasound examination of the common femoral veins is an accurate screening tool for the detection of common femoral vein thrombosis in high-risk, critically ill patients.

Design A prospective study using a focused ultrasound examination for findings consistent with deep vein thrombosis of the common femoral veins. The results of these examinations were compared with those of duplex imaging or computed tomographic venography studies.

Setting Surgical intensive care unit.

Patients All critically ill patients who were admitted to the surgical intensive care unit and considered to be at high risk for the development of deep vein thrombosis.

Main Outcome Measure Presence of deep vein thrombosis in the common femoral veins.

Results During a 16-month period, surgeons performed 306 ultrasound examinations on 220 critically ill surgical patients. The results included 295 true negative, 9 true positive, 1 false negative, and 1 false positive, yielding a 90.0% sensitivity, 99.6% specificity, and 99.3% accuracy.

Conclusion A focused, surgeon-performed ultrasound examination is a rapid and accurate screening method to detect common femoral vein thrombosis in critically ill patients as well as to examine those patients in whom pulmonary embolism is strongly suspected.

The development of deep vein thrombosis (DVT) with its potential complications significantly increases morbidity and mortality for critically ill surgical patients. Although prophylactic agents and regimens have been shown to prevent DVT in most patients, they are not completely effective.1- 5 Therefore, additional measures such as sequential compression devices for prevention and serial duplex imaging of the lower extremities for early detection are used in select patients. Although sequential compression devices are widely available, serial duplex imaging, especially in a busy surgical intensive care unit (SICU), may be difficult to do routinely because of limited resources. Furthermore, the frequency with which such a study should be done to detect occult DVT is unknown. Considering the successful use of surgeon-performed, focused ultrasound examinations in patients with multiple acute conditions, it seems reasonable to use this technology as a screening tool for the detection of occult DVT in critically ill patients.6- 9

We hypothesized that serial focused ultrasound examinations performed by surgeons could accurately detect common femoral vein (CFV) thrombosis in critically ill surgical patients. The purpose of this study was to evaluate the efficacy of a limited ultrasound examination for the detection of occult CFV thrombosis.