Dr. Peterson
Clinical question: Can hospitalists safely and accurately perform bedside deep vein thrombosis (DVT) ultrasounds to promptly diagnose DVT?
Background: DVTs are a common source of morbidity in the inpatient, non-ICU setting. Point-of-care ultrasound (POCUS) allows for timely diagnosis of DVTs by the bedside clinician, which could expedite treatment with anticoagulation to reduce venous thromboembolism (VTE) risk.
Study design: Prospective, multi-center trial comparing the sensitivity and specificity of hospitalist POCUS to the gold standard, formal vascular studies (FVS).
Setting: Inpatient, non-ICU wards at four institutions—the University of Minnesota, MedStar Georgetown University, HealthPartners/Regions, and The University of Cincinnati Medical Center.
Synopsis: Hospitalists completed two hours of didactic and hands-on POCUS training followed by 10 proctored DVT studies on standardized patients prior to participating in the study. 73 non-ICU patients were enrolled for a total of 125 extremity scans (bilateral scans were counted separately). When compared with the gold-standard FVS, sensitivity of POCUS for DVT was 100% (95% CI 74-100%) and the specificity was 95.8% (95% CI 90-98%). The POCUS results were available approximately five hours sooner than the FVS, calculated from the median time from FVS order to final report.
Some of the limitations of this study were that they did not reach their enrollment goal due to slow enrollment and low FVS orders. There was also a lower-than-expected prevalence (6.4%) of DVT in their study, which the authors attribute to scanning patients with lower pre-test DVT probability.
Bottom line: Trained hospitalists can perform lower extremity DVT POCUS with good sensitivity and specificity to help guide clinical care.
Citation: Fischer EA, et al. Hospitalist-operated compression ultrasonography: A point-of-care ultrasound study (HOCUS-POCUS). J Gen Intern Med. 2019;34(10):2062-7.
Dr. Peterson is an assistant professor of medicine at the University of Virginia School of Medicine, Charlottesville, Va.