| Accuracy | |
| Valid for practice | |
| True to literature | |
| Overall quality |
The first step is to determine your patient's pretest probability because the recommendations vary based on risk. I can tell you that many ED patients come in with a Wells score of 1-2, which places them in the "moderate pretest probability" category. There are 2 approaches you can take based on the availability of resources at your site (high-sensitivity D-dimer or U/S) and the patient's comorbidities. Are you referring your patient for a repeat outpatient ultrasound, if warranted?
Note: This card is not for the workup of recurrent or upper extremity DVTs.
Feel free to download this card and print on a 4'' x 6'' index card.
Thanks to Dr. Jason West (EM resident at Jacobi/Montefiore) for this card idea and deciphering the complex recommendations from the publication.
References
- Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD, Kearon C, Schunemann HJ, Crowther M, Pauker SG, Makdissi R, Guyatt GH; American College of Chest Physicians. Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e351S-418S. Pubmed .
- Image source
If you are interested, you can view the results of this Peer Review Demographics data.
Great comments from Peer Review Demographics:
ReplyDelete"Very useful,the ACCP guidelines can be very extensive and confusing."
"Excellent stuff. often the repeat/followup US 1 week later is forgotten, and this is a nice reminder."
I often struggle with trying to figure out the logistics of scheduling a repeat / follow up US in 1 week. At the county hospital I am at, we barely have the resources to do 1 sono, let alone a repeat. I don't want to have to be responsible for scheduling a repeat sono, and then have no way of following up on that sono (I don't even know how to order a repeat). So instead, I tel my patients to go back to their doctors for their repeat, knowing full well that there's a good chance that will never happen. Oh the challenges of our broken healthcare system!
ReplyDeleteAmen. The system doesn't work well and sadly patients fall through the cracks. It's nice to know that there may be a pathway in some instances where a negative D-Dimer can make the 1-wk repeat U/S unnecessary.
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