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Use of Bedside Ultrasound at Wexford General Hospital Emergency Department: Compliance to NICE Guidelines [NG158] for Venous Thromboembolic Disease

Published online by Cambridge University Press:  13 July 2023

Ashleigh Dowle
Affiliation:
Wexford General Hospital, Wexford, Ireland
Brendan Orsmond
Affiliation:
Wexford General Hospital, Wexford, Ireland
Darshini Vythilingam
Affiliation:
Wexford General Hospital, Wexford, Ireland
Ria Abraham
Affiliation:
Wexford General Hospital, Wexford, Ireland
Robin Andrews
Affiliation:
Wexford General Hospital, Wexford, Ireland
Rochelle Janse Van Rensburg
Affiliation:
Wexford General Hospital, Wexford, Ireland
Marco Smit
Affiliation:
Wexford General Hospital, Wexford, Ireland
Andrea Van der Vegte
Affiliation:
Wexford General Hospital, Wexford, Ireland University of South Wales, Wales, United Kingdom
Philip Jordaan
Affiliation:
Wexford General Hospital, Wexford, Ireland
Maria Conradie
Affiliation:
Wexford General Hospital, Wexford, Ireland
Keith Kennedy
Affiliation:
Wexford General Hospital, Wexford, Ireland
Bryce Wickham
Affiliation:
Wexford General Hospital, Wexford, Ireland
Thomas Kelly
Affiliation:
Wexford General Hospital, Wexford, Ireland
Michael Molloy
Affiliation:
Wexford General Hospital, Wexford, Ireland School of Medicine, UCD, Dublin, Ireland Beth Israel Deaconess Medical Center Fellowship in Disaster Medicine, Boston, USA
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Abstract

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Introduction:

Ultrasound is the standard imaging technique for diagnosing lower limb deep venous thrombosis (DVT). The National Institute for Health and Care Excellence (NICE) guidance 158 recommendation 1.1.3 states that all patients with sufficient pretest probability for DVT should be offered a proximal leg vein ultrasound within four hours. However, due to high patient volumes, formal radiology department ultrasound wait times often exceed one week. Point-of-care ultrasound (POCUS) is used to bridge diagnostic delay in our emergency department (ED) .

This study aimed to quantify numbers offered POCUS for suspected proximal lower DVT in our ED and accuracy of such studies.

Method:

A retrospective review of electronic records was conducted for patients who underwent formal lower-limb ultrasound for suspected DVT at our hospital over a three-month period (August 1, 2022-October 12, 2022). Patient charts for all ED presentations were assessed to determine whether POCUS was offered and whether DVT was diagnosed.

Statistical analysis was conducted using PRISM v9.

Results:

80 formal ultrasound scans were performed at our hospital for lower limb DVT. 58 were requested for patients presenting to ED, of which 42 had complete records available meeting selection criteria.

POCUS was offered to 24 patients in ED (57.1%). Sensitivity was 66% (95% CI 12%- 98%), and specificity was 94.1% (95% CI 75%-99%). Overall accuracy was 90%, with only one false negative study identified at formal follow-up ultrasound.

Conclusion:

Although sample size was small, our results suggest that POCUS is an accurate but underused tool to diagnose lower limb DVT. Developing a standardized protocol for performing and reporting POCUS DVT scans in ED should allow for earlier diagnosis and initiation of appropriate treatment where necessary.

Type
Poster Presentations
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine