Improved selection criteria for ordering stat venous ultrasounds from the emergency department

Background: The accuracy and convenience of venous ultrasound (VU) to exclude deep vein thrombosis (DVT) has led to indiscriminate use and low positive yield rates. Methods: A total of 256 patients were referred from our emergency department (ED) for stat VU during a 2-year period (1995 to 1996). The VUs were interpreted as normal in 198 (77%). Positive findings were discovered in 58 (23%), with DVT accounting for 43 (17%). Retrospective multivariant analysis was used to identify predictive indicators. Results: Unilateral leg swelling/edema identified 36 of 40 (90%) patients with DVT and 8 of 10 (80%) with other thrombotic disorders (saphenous and/or chronic venous thrombosis). A history of leg pain with prior DVT or recent trauma ≤3 days’ duration increased DVT duration to 98% (39 of 40). Using these criteria, a 47% charge reduction would have been recognized. Conclusions: Improving ED screening criteria can safely increase yield rate and reduce charges with minimal loss of VU sensitivity.