Accuracy of ultrasonography performed by critical care physicians for the diagnosis of DVT

Chest. 2011 Mar;139(3):538-542. doi: 10.1378/chest.10-1479. Epub 2010 Oct 28.


Background: DVT is common among critically ill patients. A rapid and accurate diagnosis is essential for patient care. We assessed the accuracy and timeliness of intensivist-performed compression ultrasonography studies (IP-CUS) for proximal lower extremity DVT (PLEDVT) by comparing results with the formal vascular study (FVS) performed by ultrasonography technicians and interpreted by radiologists.

Methods: We conducted a multicenter, retrospective review of IP-CUS examinations performed in an ICU by pulmonary and critical care fellows and attending physicians. Patients suspected of having DVT underwent IP-CUS, using a standard two-dimensional compression ultrasonography protocol for the diagnosis of PLEDVT. The IP-CUS data were collected prospectively as part of a quality-improvement initiative. The IP-CUS interpretation was recorded and timed at the end of the examination on a standardized report form. An FVS was then ordered, and the FVS result was used as the criterion standard for calculating sensitivity and specificity. Time delays between the IP-CUS and FVS were recorded.

Results: A total of 128 IP-CUS were compared with an FVS. Eighty-one percent of the IP-CUS were performed by fellows with <2 years of clinical ultrasonography experience. Prevalence of DVT was 20%. IP-CUS studies yielded a sensitivity of 86% and a specificity of 96% with a diagnostic accuracy of 95%. Median time delay between the ordering of FVS and the FVS result was 13.8 h.

Conclusions: Rapid and accurate diagnosis of proximal lower extremity DVT can be achieved by intensivists performing compression ultrasonography at the bedside.

Publication types

  • Evaluation Study
  • Multicenter Study

MeSH terms

  • Critical Care*
  • Humans
  • Lower Extremity / blood supply
  • Lower Extremity / diagnostic imaging
  • Physicians*
  • Prospective Studies
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity
  • Ultrasonography, Doppler / methods*
  • Venous Thrombosis / diagnostic imaging*