ABSTRACT
OBJECTIVE: To assess the safety of using single complete compression ultrasonography in pregnant and postpartum women to rule out deep vein thrombosis. DESIGN: Prospective outcome study. SETTING: Two tertiary care centres and 18 private practices specialising in vascular medicine in France and Switzerland. PARTICIPANTS: 226 pregnant and postpartum women referred for suspected deep vein thrombosis. METHODS: A single proximal and distal compression ultrasonography was performed. All women with a negative complete compression ultrasonography result did not receive anticoagulant therapy and were followed up for a three month period. MAIN OUTCOME MEASURES: Symptoms of venous thromboembolism, second compression ultrasonography or chest imaging, a thromboembolic event, and anticoagulant treatment. RESULTS: 16 women were excluded, mainly because of associated suspected pulmonary embolism. Deep vein thrombosis was diagnosed in 22 out of the 210 included women (10.5%). 10 patients received full dose anticoagulation despite a negative test result during follow-up. Of the 177 patients without deep vein thrombosis and who did not receive full dose anticoagulant therapy, two (1.1%, 95% confidence interval 0.3% to 4.0%) had an objectively confirmed deep vein thrombosis during follow-up. CONCLUSIONS: The rate of venous thromboembolic events after single complete compression ultrasonography in pregnant and postpartum women seems to be within the range of that observed in studies in the non-pregnant population. These data suggest that a negative single complete compression ultrasonography result may safely exclude the diagnosis of deep vein thrombosis in this setting. TRIAL REGISTRATION: clinicaltrials.gov NCT00740454.
Subject(s)
Lower Extremity/diagnostic imaging , Pregnancy Complications, Cardiovascular/diagnostic imaging , Ultrasonography/methods , Venous Thrombosis/diagnostic imaging , Adult , Anticoagulants/administration & dosage , Anticoagulants/therapeutic use , Diagnostic Errors , Female , Follow-Up Studies , Humans , Lower Extremity/blood supply , Phlebography , Postpartum Period , Predictive Value of Tests , Pregnancy , Prospective StudiesABSTRACT
STUDY OBJECTIVE: We compare the performance of a wrist blood pressure oscillometer with the mercury standard in the triage process of an emergency department (ED) and evaluate the impact of wrist blood pressure measurement on triage decision. METHODS: Blood pressure was successively measured with the standard mercury sphygmomanometer and with the OMRON-RX-I wrist oscillometer in a convenience sample of 2,493 adult patients presenting to the ED with non-life-threatening emergencies. Wrist and mercury measures were compared using criteria of the Association for the Advancement of Medical Instrumentation (AAMI) and the British Hypertension Society (BHS). The impact on triage decisions was evaluated by estimating the rate of changes in triage decisions attributable to blood pressure results obtained with the wrist device. RESULTS: Wrist oscillometer failed to meet the minimal requirements for recommendation by underestimating diastolic and systolic blood pressure. Mean (+/-SD) differences between mercury and wrist devices were 8.0 mm Hg (+/-14.7) for systolic and 4.2 mm Hg (+/-12.0) for diastolic measures. The cumulative percentage of blood pressure readings within 5, 10, and 15 mm Hg of the mercury standard was 32%, 58%, and 72% for systolic, and 40%, 67%, and 83% for diastolic measures, respectively. Using the wrist device would have erroneously influenced the triage decision in 7.6% of the situations. The acuity level would have been overestimated in 2.2% and underestimated in 5.4% of the triage situations. CONCLUSION: The performance of the OMRON-RX-I wrist oscillometer does not fulfill the minimum criteria of AAMI and BHS compared with mercury standard in the ED triage setting.
