POCUS can be used by hospitalists to rule out DVT in ward patients

Point-of-care ultrasound (POCUS) showed a sensitivity of 100%, a specificity of 95.8%, a positive predictive value of 61.5%, and a negative predictive value of 100% for diagnosing deep venous thrombosis (DVT) in a prospective study.

Hospitalists effectively used point-of-care ultrasound (POCUS) to rule out deep venous thrombosis (DVT) in non-ICU patients, a recent study found.

The prospective cohort study enrolled a convenience sample from four tertiary care hospitals of hospitalized non-ICU patients for whom a DVT ultrasound was ordered. Hospitalists performed POCUS with a three-region compression protocol to look for DVT, and the results were compared with the corresponding formal vascular study interpreted by radiologists. The study was published by the Journal of General Internal Medicine on Aug. 6.

A total of 125 limbs from 73 patients were scanned, and DVT was found in eight (6.4%). This was a lower prevalence than expected. The sensitivity of POCUS for DVT was 100% (95% CI, 74% to 100%) and specificity was 95.8% (95% CI, 91% to 98%), with a positive predictive value of 61.5% (95% CI, 35% to 84%) and a negative predictive value of 100% (95% CI, 98% to 100%). The hospitalist-operated compression ultrasonography (HOCUS) was completed substantially faster than formal vascular studies; the median time from order to POCUS completion was 5.8 hours, compared to 11.5 hours from order until finalized radiology report (P=0.001).

This is the first study to look at POCUS for DVT diagnosis in non-ICU hospitalized patients, according to the study authors, and it “shows that hospitalists can be trained to competently perform POCUS with good sensitivity and excellent specificity.” The results suggest that a negative POCUS finding could rule out DVT in a hospitalized patient, although more research is needed to determine how to act on a positive POCUS, they said.

The authors noted that the participating hospitalists underwent only two hours of training and 10 practice scans on standardized patients. The study did have limitations, particularly its small sample size. The low DVT prevalence led to a low positive predictive value for POCUS, but the authors speculated that many of the false positives in the study would not have occurred in practice, where hospitalists could choose to do POCUS based on patients' pretest probability for DVT.

“Further study is needed to ensure generalizability of our findings, understand how to integrate this into a hospitalist's workflow, and consider how this approach might be shared with trainees,” they concluded.