Point of Care Ultrasound For The Diagnosis Of Deep Venous Thrombosis And Its Effect On Length Of Hospital Stay
Point of Care Ultrasound For The Diagnosis Of Deep Venous Thrombosis And Its Effect On Length Of Hospital Stay
This is a Clinical Trial on the use of Point Of Care Ultrasound for the diagnosis of deep
 venous thrombosis (DVT) and its effect on length of hospital stay. 25 participants with
 suspicion of DVT according to Wells Criteria were randomized to one of two groups: Point of
 Care Ultrasound and Echo Doppler Ultrasound (POCUS + EDUS), and the control group was
 submitted only to the Echo Doppler Ultrasound (EDUS). The primary outcome was hospital stay.
Because of high mortality associated with venous thrombosis (pulmonary embolism and deep
 venous thrombosis - DVT) the early recognition and therapeutics of its condition are crucial.
 Point of Care Ultrasound (POCUS) is a method with high sensibility to diagnose DVT and it is
 as accurate as Echo Doppler Ultrasound (EDUS), however the use of POCUS for diagnosis of DVT
 in the emergency care still presents resistance. This is a Clinical Trial on the use of POCUS
 for the diagnosis of DVT and its effect on length of hospital stay. 25 participants were
 randomized into two groups. The randomization was done through the random.org site in blocks
 of 4, a randomization list was with one researcher (blind) of the study. The experimental
 group was first submitted to POCUS in the Emergency Room, performed by a resident physician
 of Internal Medicine with training in POCUS, then after submitted to EDUS in the Radiology
 Service by a Radiologist. The control group was submitted only to EDUS in the Radiology
 Service. The 2-point compression technique was used, as described in previous studies, using
 the portable ultrasound device (M-turbo Sonosite) with a high frequency linear transducer
 (5-10 MHZ). The sites used in the evaluation were the popliteal site comprising the popliteal
 vein and trifurcation of the popliteal vein and the femoral point in which comprises the
 sapheno-femoral junction, the common femoral vein and the superficial femoral vein, all
 evaluated in the transverse plane. The result was considered positive for DVT when the vessel
 evaluated showed no compressibility and / or presented echogenic material in the lumen of the
 vein. After the randomization, the patients were followed for a period of 30 days, being
 evaluated in three moments: initial evaluation, at 7 and 30 days of the initial evaluation.
 Whenever possible, each evaluation was in person. In the initial evaluation, the
 participant's demographics, date and time of arrival at the Emergency Service, previous
 illnesses, Wells criteria score and reason for the initial care were collected. Participants
 randomized to the POCUS + EDUS group had recorded date and time of ultrasound at the bedside
 and, if there was confirmation of DVT, these data were collected by the resident physician,
 blinded for the Echo Doppler Ultrasound results. EDUS data, such as date and time of the
 examination request, date and time of the release of the exam report, confirmation of DVT,
 date and time of discharge were collected by another researcher, blinded to the participant's
 group and to the POCUS's results. After 7 and 30 days the outcomes were recorded: time for a
 first diagnostic information, time to therapeutic decision making / prescription, length of
 hospital stay, death, pulmonary thromboembolism, bleeding or other complication,
 re-hospitalization, evolution to DVT in cases that were initially negative.
Inclusion Criteria:

 -  Low, moderate or high suspicion of DVT by Wells Criteria.

 -  Patients with Echo-Doppler Ultrasonography already requested in the hospital system.

 Exclusion Criteria:

 -  Myocardial Infarction, Stroke or Cardiac Surgery within 3 months prior to hospital
 admission;

 -  Renal Chronic Disease (Clinical Stages IV and V);

 -  Congestive Heart Failure (NYHA IV);

 -  Pregnancy;

 -  Previous episode of DVT in the same leg that of the current DVT suspicion;

 -  Patients already in treatment for DVT or taking anticoagulants for any other reason.