The exclusion of acute venous thrombosis in ER: experience in Udine

Doctors working in an Emergency Department often deal with patients with suspected deep venous thrombosis (DVT). They use the clinical exam (medical history, physical examination), useful to predict the risk of the pathology also with the aim of validated scores, the ultrasonography, expecially in the form of the serial 2-point compression ultrasonography (CUS) and of the D-dimer assay, whose role is great in excluding thromboembolism in low risk patients but, because of the low specificity, is high in many clinical conditions other than thrombosis. More over it requires long times of execution, prolonging the time which occurs for the evaluation of the patients. We analyzed consecutive patients with suspected DVT evaluated in one year of activity in our Emergency Department. Our diagnostic strategy consisted in the use of clinical probability of DVT score and CUS, avoiding D-dimer assay. Among the 549 non excluded patients we diagnosed DVT in 48 cases; in 3 of them it was associated with pulmonary embolism (PE). Patients in which DVT was excluded and discharged from the hospital were contacted 6 months after to identify thromboembolic events. We discovered 3 cases of venous thromboembolism among the 339 patients who underwent telephonic follow-up: of this one asyntomatic PE (incidental diagnosis) and two DVT, occurred in patients who were previously diagnosed a superficial venous thrombosis. The method utilized in our Emergency Department is therefore safe and efficient.