--- Steve <[log in to unmask]> wrote:
> Doppler ultrasound is used by many trust as the
> investigation of choice. The
> problem with this is that below knee dvt cannot be
> accurately diagnosed and
> is operator dependant. DVT the cause of PE in 90% of
> cases but only found in
> 50% of cases by doppler!
>
I understand from the radiologists that Compression
U/S will be taking over from Doppler and is much less
operator dependant.
> Venometry seems to be a useful screening tool it has
> similiar positive
> prediction to d-dimers and has the advantage of
> testing the anatomical
> location.
>
> Therefore it does seem that d-dimer plays fourth
> fiddle and therefore can be
> disregarded in dvt protocols although is an
> important test when excluding
> PE- but remember less than 10% of the elderly will
> ever have a negative
> d-dimer.
>
> So the question in dvt is why do we need to diagnose
> dvt? If you want to
> prevent post thrombotic symptoms in all concerned
> then you are unlikely to
> succeed, however if you are only worried about
> pulmonary embolus than you
> are concerned with diagnosing clinically significant
> disease and not all
> dvts.
>
> Therefore bin d-dimers.
> Screen with venometry (strain gauge)
> If positive doppler
> If positive treat, if negative in venometry or
> doppler re-evaluate in 5-7
> days.
>
A few questions.
Who does the venometry?
Is it available 24/7 or at least 8/7?
What do you do with patients in plaster?
We had a young man die of PE who developed a DVT while
in POP!
Thanks,
Fred.
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