A systematic review of the accuracy of ultrasound in the diagnosis of deep venous thrombosis in asymptomatic patients

Behrouz Kassaï; Jean-Pierre Boissel; Michel Cucherat; Sandrine Sonie; Nirav R. Shah; Alain Leizorovicz

doi:10.1160/TH03-11-0722

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2004; 91(04): 655-666
DOI: 10.1160/TH03-11-0722

Review Article

Schattauer GmbH

A systematic review of the accuracy of ultrasound in the diagnosis of deep venous thrombosis in asymptomatic patients

Authors

Behrouz Kassaï

¹Department of Clinical Pharmacology / EA3736, University of Lyon, France
Jean-Pierre Boissel

¹Department of Clinical Pharmacology / EA3736, University of Lyon, France
Michel Cucherat

¹Department of Clinical Pharmacology / EA3736, University of Lyon, France
Sandrine Sonie

²Department of Child Psychiatry / ITTAC, University of Lyon, France
Nirav R. Shah

³Division of Primary Care, New York University, New York, USA
Alain Leizorovicz

¹Department of Clinical Pharmacology / EA3736, University of Lyon, France

Abstract

Summary

Evaluation of the accuracy of ultrasound has yielded heterogeneous results. Our objective was to summarize the evidence on the accuracy of ultrasound compared to venography in asymptomatic patients, taking into account the variation due to threshold differences. Searches of journal table of contents, computer databases (Medline, Embase, Biomed, Cochrane) and conference proceedings were performed. A study was eligible if it prospectively compared ultrasound to venography for the diagnosis of DVT in asymptomatic patients. Data of studies selected for inclusion were extracted independently by two authors. High quality studies with consecutive patient enrollment, blind evaluation of the two techniques, and absence of verification bias are summarized as Level 1, while those not fulfilling one or more of these criteria are considered Level 2. Original study authors were contacted to confirm accuracy and to provide missing data. A pooled estimate of the accuracy of ultrasound was obtained according to the method of Moses and coworkers. This method gives a summary diagnostic odds ratio (DOR). The DOR is a single indicator of test performance. It varies between 0 and infinity and exceeds 1, only when ultrasound is more often positive in patients with DVT relative to those without DVT. Higher DOR indicates better discriminatory test performance. Thirty one studies were rated as potentially unbiased and graded as Level 1.The mean prevalence of DVT as determined by venography was 22%. In Level 1 studies, the odds of positive ultrasound in proximal veins was 379 times higher (95% confidence limits 65, 2,200) and in distal veins 32 times higher (7.5, 135) among patients with DVT than those without. Our results suggest that, particularly for proximal veins, ultrasound is accurate for the diagnosis of DVT in asymptomatic postoperative orthopedic patients. More research is needed in other clinical settings.

Keywords

Meta-analysis - accuracy - venous thrombosis - venography - ultrasonography

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Referenzen

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