All Journals from Brian C Lee
Abstract
Suspected deep vein thrombosis (DVT) is a common reason for medical referral to hospital. We evaluated our new approach to assessment of DVT using combined automated strain gauge plethysmography and pretest probability score in comparison with venous ultrasonography in 100 consecutive patients with suspected DVT referred to the nurse-led clinic. The combined plethysmography and pretest probability score produced a negative predictive value of 99%, positive predictive value 53%, sensitivity 94% and specificity 83% for detection of a DVT. We conclude that our new working practice for DVT assessment is both safe and cost effective and can lead to a reduction in venous ultrasonography of approximately 70%.
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A key component of training in Acute Medicine is the assessment and initial resuscitation of severely ill medical patients. The curriculum for General Internal Medicine (Acute Medicine) states that all specialists in Acute Medicine should attain Level 3 competencies in all emergency presentations.1 Different training programmes have variable exposure to the emergency department, to which the majority of these patients present. One module, currently being developed at City Hospital, Birmingham, is for the Acute Medicine Specialist Registrars (SpRs) to attend all medical alerts in Accident and Emergency (A&E) Department. This means that the SpR works as part of the receiving team, seeing patients first hand, rather than taking secondary referrals. At our hospital over 80% of alerts brought in the resuscitation room are medical emergencies.
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