TY - JOUR
T1 - Role of venous duplex scanning in patients with suspected pulmonary embolism
AU - Matteson, B.
AU - Langsfeld, M.
AU - Schermer, C.
AU - Johnson, W.
AU - Weinstein, E.
PY - 1996
Y1 - 1996
N2 - Purpose: We examined the use of venous duplex scanning (VDS) in the diagnosis of pulmonary embolism (PE) at our institution. Methods: Patients undergoing lower extremity VDS from October 1988 through June 1995 were cross-referenced with those who underwent ventilation perfusion (V/Q) scans and pulmonary angiography (PA) for PE. Results: A total of 664 of 3534 VDS were for 'rule out PE.' Deep venous thrombosis was found in 13%. A total of 256 VDS were in conjunction with V/Q scans in 249 patients, with only 8% undergoing PA. Deep venous thrombosis was present in 18% for those with both V/Q and VDS compared with 10% (p < 0.01) for those with VDS as the sole study. The order in which V/Q, VDS, and PA were obtained and the relationship of positive studies was examined. Conclusion: We found no pattern to the sequence of tests ordered. V/Q scan rather than VDS should be the first study in the evaluation of PE. PE was diagnosed or excluded in nearly one third of patients based on V/Q as the initial study. A total of 29% of VDS could have been avoided. Treatment could be determined on the basis of VDS as the initial study in only 13%. We found only 14% incidence of positive PA in patients with nondiagnostic V/Q scans. We advocate judicious use of diagnostic tests in a stepwise fashion to appropriately treat patients with suspected PE.
AB - Purpose: We examined the use of venous duplex scanning (VDS) in the diagnosis of pulmonary embolism (PE) at our institution. Methods: Patients undergoing lower extremity VDS from October 1988 through June 1995 were cross-referenced with those who underwent ventilation perfusion (V/Q) scans and pulmonary angiography (PA) for PE. Results: A total of 664 of 3534 VDS were for 'rule out PE.' Deep venous thrombosis was found in 13%. A total of 256 VDS were in conjunction with V/Q scans in 249 patients, with only 8% undergoing PA. Deep venous thrombosis was present in 18% for those with both V/Q and VDS compared with 10% (p < 0.01) for those with VDS as the sole study. The order in which V/Q, VDS, and PA were obtained and the relationship of positive studies was examined. Conclusion: We found no pattern to the sequence of tests ordered. V/Q scan rather than VDS should be the first study in the evaluation of PE. PE was diagnosed or excluded in nearly one third of patients based on V/Q as the initial study. A total of 29% of VDS could have been avoided. Treatment could be determined on the basis of VDS as the initial study in only 13%. We found only 14% incidence of positive PA in patients with nondiagnostic V/Q scans. We advocate judicious use of diagnostic tests in a stepwise fashion to appropriately treat patients with suspected PE.
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U2 - 10.1016/S0741-5214(96)70011-3
DO - 10.1016/S0741-5214(96)70011-3
M3 - Article
C2 - 8918322
AN - SCOPUS:0029911082
VL - 24
SP - 768
EP - 773
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
SN - 0741-5214
IS - 5
ER -