Duplex scanning is utilised by many departments in the investigation of suspected Deep Vein Thrombosis (DVT). NICE Guideline CG144 recommended repeat scanning for patients in whom the initial Wells score was ‘likely’ in the presence of a raised D-Dimer, following a normal first scan. Following implementation of this recommendation in our department there was a dramatic rise in the number of repeat scans being undertaken, all of which were negative for DVT. Introduction of an electronic message to the report, placing the onus back on the referring clinician to arrange repeat scan if deemed appropriate resulted in a fall in the number of scans being undertaken without impacting on patient outcome.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. Venous Thromboembolic Diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing (CG144 published June 2012). www. nice.org.uk
2. Wells PS, Anderson DR, Bormanis J, et al. Value of assessment of pre-test probability of deep-vein thrombosis in clinical management. Lancet. 1997; 350(9094): 1795–1798.
3. Guidelines on the diagnosis and management of acute pulmonary embolism .The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Eur Heart J (2008); 29(18): 2276–2315.
4. Bayes HK, O’Dowd CA, Glassford NJ, et al. D-dimer assays – a help or hindrance in suspected pulmonary thromboembolism assessment? J Postgrad Med 2011; 57(2): 109–114.
5. Hager K, Platt D. Fibrin degradation product concentrations (D-dimers) in the course of ageing. Gerontology 1995; 41: 159–65.
6. Goodacre S, et al. Measurement of the clinical and costeffectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis. Health Technol Assess 2006; 10(15): 1–168.
7. Holland M, Morris K. Full leg venous duplex scans versus proximal leg vein scans in the investigation of suspected DVT: Clinical and economic evaluation (poster abstract). Acute Medicine, 2014; 13(4): 167–8.