Saturday, March 7, 2009

DVT Detection

A Deep Vein Thrombosis (DVT - basically a clot) could be a very serious condition if unrecognized. In our clinic we recently had an instance of a patient (4 weeks post-op) presenting with a few signs of this possibility and we referred him back to his MD to check it out and it turned out he had 3 small DVT's.

In the November 2008 issue of NAJSPT in an article titled "Multiple Ligament Knee Injury: Complications" there is a very clinically relevant decision rule that we have posted in our clinic as a constant reminder to look out for this complication. The original Clinical Decision Rule was actually developed in this citation:

Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Wells PS et al. Lancet. (1997)

Just as I think everyone, medical personnel and lay people, should be certified in CPR, the detection of DVT should be a critical skill that anyone exposed to a post-operative patient should have. So here are the clinical findings to look for. Each is a point towards the decision rule score, except for the last one which subtracts 2points from the score.

-advanced cancer (w/in 6 mo's of Dx or palliative care)
-paralysis, paresis, or recent plaster immobilization of lower extremity (LE)
-recently bedridden >3 days or major Sx w/4 wks of application of clinical decision rule
-localized tenderness along distribution of the deep venous system
-entire LE swelling
-calf swelling >3cm compared to asymptomatic LE
-pitting edema (>in symptomatic LE)
-collateral superficial veins (nonvaricose)
-alternative Dx as likely, or > than DVT = -2

Total of Above Score
High probability >3
Moderate probability 1 or 2
Low probability <0

Here is a very similar version of this toward the bottom with different references (that came out in 1998 one year after the release of the one I reference, odd to me).

1 comment:

t-denninger said...

It is beyond me that this is not better well known and the Homan's sign, a test with absolutely zero clinical utility, is still the norm. Check out the video by Sacred Heart University's 2009 graduates on Wells Wells Baby...