Background: Deep Vein Thrombosis (DVT) is a pathology characterized by the formation of a blood clot inside the venous system. It comprises either distal vein thrombosis, but also proximal vein thrombosis (i.e. Femoral, Popliteal and Iliacal veins), which leads to a significant increase in complications of the disease, such as pulmonary thromboembolism (PE) and even death. Prompt recognition and treatment of the disease is paramount for the reduction of such complications. Nevertheless, early treatment without disease comprovation can also be damaging, since it is based in the use of anticoagulants, leading to a potential increase in bleeding events.
Methods: We prospectively evaluated patients hospitalized in an Internal Medicine ward with suspected DVT. PoCUS was performed by the ‘Procedures Team’ of the Internal Medicine residency program of Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil, which is composed of one preceptor and two second year residents. The results were later compared with the gold standard method, doppler ultrasound performed by either a radiologist or vascular surgeon. Inclusion criteria were being 18 years old or older, hospitalized in the Internal Medicine ward or being in clinical-surgical co-management and having DVT suspected by the attending physician. Exclusion criteria was having doppler US already performed, having a central venous line in the affected limb or having extensive skin lesions in the site to be evaluated. Accuracy was calculated, as well as sensitivity, specificity, positive predictive value and negative predictive value.
Results: Between April and December/2018, 96 patients hospitalized in an Internal Medicine ward with suspected DVT were evaluated. The accuracy of the method, as compared to the gold standard was 96.88% (95% CI 91.14 – 99.35%), with a 96.67% sensitivity (95% CI 82.78 – 99.92%) and 96.97% specificity (95% CI 89.48 – 99.63%). Positive predictive value was 93.55% (95% CI 78.71 – 98.27%) and negative predictive value was 98.46% (95% CI 90.30 – 99.77).
Conclusions: The diagnosis of proximal-DVT can accurately and promptly be made by Internal Medicine Residents with proper training, providing fast treatment or exclusion of due pathology. Although the method does not rule out the necessity of a proper diagnosis made by a specialist for diagnosis of thrombosis in distal sites, it affords for early treatment or even early anticoagulant interruption, being a good tool to minimize potential complications of an untreated disease, or even of an incorrect treatment.