Detection Of Deep Vein Thrombosis Research Articles

Ultrasound surveillance for deep venous thrombosis and subsequent venous thromboembolism in adults with trauma: A systematic review and meta-analysis.

Studies have shown routine ultrasound surveillance (RUSS) will facilitate deep vein thrombosis (DVT) detection in patients with trauma and reduce the subsequent incidence of pulmonary embolism (PE); however, the findings were inconsistent. In adults with trauma at a high risk of venous thromboembolism, this systematic review and meta-analysis compared RUSS outcomes with those of "no RUSS." Three databases were screened for relevant articles from inception to October 18, 2021. Randomized controlled trials (RCTs) and observational studies comparing RUSS with no RUSS were included. We used relative risks (RRs), odds ratios (ORs), and mean differences to pool effect estimates for dichotomous and continuous outcomes. The cochrane risk of bias or the risk of bias in non-randomized studies of interventions were used to assess bias risk. The grading of recommendations, assessment, development, and evaluation framework assessed the certainty of the evidence. Out of 1685 articles, 5 met the inclusion criteria (RCT: 1; observational studies: 4). Observational studies suggested RUSS is associated with higher odds of DVT detection (OR, 4.87; 95% confidence interval [CI], 3.13-7.57; very low certainty). Whereas higher risks of DVT were associated with RUSS in the RCT (distal DVT: RR, 15.48; 95% CI, 7.62-31.48; low certainty, and proximal DVT: RR, 2.37; 95% CI, 1.04-5.39; very low certainty). Reduced odds of PE risk were observed with the RUSS (OR, 0.47; 95% CI, 0.24-0.91; very low certainty). Observational studies indicated that RUSS had an uncertain effect on mortality (OR, 0.46; 95% CI, 0.06-3.49). In the RCT, times to proximal and distal DVT diagnoses were shorter with RUSS (proximal DVT, mean difference 2.25 days shorter [95% CI, 5.74-1.24]; distal DVT, mean differences 1.56 days shorter [95% CI, 4.22-1.12]; very low certainty for both). Increasing bleeding risk was not linked to the RUSS group (RR, 1.24; 95% CI, 0.31-4.92). The RUSS efficacy in adults with trauma at high risk for venous thromboembolism showed that it increases DVT detection, decreases PE incidence, and shortens the time to DVT diagnosis, with an uncertain impact on mortality. The evidence is low or very low in certainty because of bias, inconsistency, imprecision, and indirectness.

HIDDEN2: Study protocol for the hospital deep vein thrombosis detection study in patients with cancer receiving palliative care

IntroductionMedical patients, admitted acutely to hospital, are at risk of venous thromboembolism (VTE). Clinical guidelines advise thromboprophylaxis prophylaxis for those at high risk of VTE. VTE is a common sequela...

Risk factors of deep vein thrombosis in children with osteomyelitis

Objective To investigate the risk factors for deep vein thrombosis (DVT) in children with osteomyelitis and provide diagnostic and treatment strategies for the prevention, early detection and treatment of DVT. Study design The clinical data of nine children diagnosed with osteomyelitis and DVT between July 2012 and March 2021 were collected at our hospital, including age, sex, clinical manifestations, body temperature, coagulation function and other data, as well as the clinical data of 27 children diagnosed with osteomyelitis without DVT during the same period. Thirty-six children were divided into thrombus and thrombus-free groups. The clinical characteristics and risk factors for DVT in children with osteomyelitis were analysed. Results Among the 36 children in this study, nine cases of thrombus formation mainly occurred in the femoral vein, popliteal vein and iliac vein, all near the infection site. The main clinical manifestations were lower extremity pain, swelling and pulmonary embolism in three cases. Among them, intensive care unit (ICU) admission, sepsis, higher D-dimer, higher body temperature during hospitalization, and pathogen culture showed that methicillin-resistant Staphylococcus aureus (MRSA) was associated with DVT. MRSA was the independent risk factor for DVT. Conclusions Admission to ICU, sepsis, higher D-dimer, higher body temperature during hospitalization, and MRSA are risk factors for thrombosis. MRSA is the independent risk factor for DVT. For patients with related risk factors, timely ultrasound examination of the infected site should be considered to achieve early detection and treatment.

Natural Language Processing in a Clinical Decision Support System for the Identification of Venous Thromboembolism: Algorithm Development and Validation

It remains unknown whether capturing data from electronic health records (EHRs) using natural language processing (NLP) can improve venous thromboembolism (VTE) detection in different clinical settings. The aim of this study was to validate the NLP algorithm in a clinical decision support system for VTE risk assessment and integrated care (DeVTEcare) to identify VTEs from EHRs. All inpatients aged ≥18 years in the Sixth Medical Center of the Chinese People's Liberation Army General Hospital from January 1 to December 31, 2021, were included as the validation cohort. The sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-, respectively), area under the receiver operating characteristic curve (AUC), and F1-scores along with their 95% CIs were used to analyze the performance of the NLP tool, with manual review of medical records as the reference standard for detecting deep vein thrombosis (DVT) and pulmonary embolism (PE). The primary end point was the performance of the NLP approach embedded into the EHR for VTE identification. The secondary end points were the performances to identify VTE among different hospital departments with different VTE risks. Subgroup analyses were performed among age, sex, and the study season. Among 30,152 patients (median age 56 [IQR 41-67] years; 14,247/30,152, 47.3% females), the prevalence of VTE, PE, and DVT was 2.1% (626/30,152), 0.6% (177/30,152), and 1.8% (532/30,152), respectively. The sensitivity, specificity, LR+, LR-, AUC, and F1-score of NLP-facilitated VTE detection were 89.9% (95% CI 87.3%-92.2%), 99.8% (95% CI 99.8%-99.9%), 483 (95% CI 370-629), 0.10 (95% CI 0.08-0.13), 0.95 (95% CI 0.94-0.96), and 0.90 (95% CI 0.90-0.91), respectively. Among departments of surgery, internal medicine, and intensive care units, the highest specificity (100% vs 99.7% vs 98.8%, respectively), LR+ (3202 vs 321 vs 77, respectively), and F1-score (0.95 vs 0.89 vs 0.92, respectively) were in the surgery department (all P<.001). Among low, intermediate, and high VTE risks in hospital departments, the low-risk department had the highest AUC (1.00 vs 0.94 vs 0.96, respectively) and F1-score (0.97 vs 0.90 vs 0.90, respectively) as well as the lowest LR- (0.00 vs 0.13 vs 0.08, respectively) (DeLong test for AUC; all P<.001). Subgroup analysis of the age, sex, and season demonstrated consistently good performance of VTE detection with >87% sensitivity and specificity and >89% AUC and F1-score. The NLP algorithm performed better among patients aged ≤65 years than among those aged >65 years (F1-score 0.93 vs 0.89, respectively; P<.001). The NLP algorithm in our DeVTEcare identified VTE well across different clinical settings, especially in patients in surgery units, departments with low-risk VTE, and patients aged ≤65 years. This algorithm can help to inform accurate in-hospital VTE rates and enhance risk-classified VTE integrated care in future research.

Comparison of Two-Point Compression Ultrasonography Performed by Emergency Medicine Doctors and Radiologists in Detection of Deep Vein Thrombosis

AbstractVenous thromboembolism (VTE) is a serious coagulation disorder that includes deep vein thrombosis (DVT) and pulmonary embolism and is an important cause of hospitalization and death. This study aimed to evaluate the compliance of the emergency doctor and radiologist in diagnosing DVT in the emergency department using the two-point compression ultrasonography (USG) method. Patients and Methods This prospective cross-sectional study was performed between February and July 2022 in the Emergency Medicine Clinic of a tertiary university hospital with patients who were thought to have DVT and had lower extremity venous USG indication. Demographic information of patients, clinical markers used in the Wells score, and USG results of the emergency doctors and radiologists were recorded in the study form. Results A total of 400 patients were included in the study. The mean age of the study patients was 59.8 ± 18.0 years, and 54.4% (n = 217) of the patients were male. There was a significant difference in the incidence of DVT between those with a Wells score of 2 or less and those above 2 (n = 67, 21.8% vs. n = 41, 47.1%; p &lt; 0.001). Regarding interobserver agreement in the evaluation of DVT by emergency medicine doctor and radiologist, kappa values were 0.81 (95% confidence interval [CI]: 0.71–0.91) for the right femoral vein, 0.89 (95% CI: 0.81–0.97) for the left femoral vein. It was found to be 0.81 (95% CI: 0.76–0.86) for all lower extremity vein USGs. Conclusions There is a very good level of agreement between the emergency department and the radiologist in diagnosing DVT with USG.

Point-of-Care Testing in the Diagnosis of Deep Vein Thrombosis: A Review

Deep vein thrombosis (DVT) is a venous reflux disorder disease caused by abnormal blood coagulation in the deep veins. It frequently occurs in the lower limbs of orthopedic patients, pregnant women, and the elderly. DVT can easily cause a pulmonary embolism (PE), a disease with a high mortality rate. Therefore, the detection and processing of DVT are crucial. Based on traditional diagnostic management, doctors use D-dimer and ultrasound (US) for screening and diagnosis. However, it does not work well for early diagnosis, and the cost to the health-care system is enormous. Early detection and continuous monitoring are the urgent capabilities that current diagnostic equipment needs. Point-of-care testing (POCT) equipment is a type of detection equipment that can diagnose independently and also has the advantages of stability, reliability, easy care, and long-term monitoring. It has a wide application scenario and can be used away from the service and inspection centers, for example, in telemedicine, outdoor first aid, and community health care. POCT equipment also benefits new development in the early diagnosis of DVT. This article presents the history of diagnostic procedures and a clinical diagnostic approach to DVT. We investigate the early diagnosis of DVT based on the characteristics of POCT equipment. We present the current state, benefits, and drawbacks of POCT diagnostic equipment, including POC D-dimer, POC US (POCUS), and photoplethysmography (PPG). In addition, we analyze performance measures from research methods, such as sensitivity and specificity. Finally, we outline the developing trends of DVT detection methods and propose several issues that need to be addressed.

Hematological Parameters as an Early Marker of Deep Vein Thrombosis in Diabetes Mellitus: An Observational Study.

Background Although the association between the presence of diabetes mellitus and the development of deep vein thrombosis (DVT) is well known, the role of novel biomarkers in predicting the development of DVT in diabetic patients is not yet known to a large extent.Studies have shown that complete blood count (CBC) and CBC-derived parameters such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) can be used as surrogate markers to detect DVT. This study was conducted to assess the utility of NLR and PLR as a marker of DVT in diabetic patients. Methodology This case-control study was conducted among a calculated sample size of 109 DVT patients in one arm and 109 non-DVT patients in another arm.Hematological tests including total leucocyte count, differential leucocyte count, total neutrophil count, total lymphocyte count, total platelet count, NLR, and PLR were performed. Results We found a significant difference in NLR and PLR between the DVT and the non-DVT groups. In addition, we found that NLR and PLRwere significantly higher in the diabetic group, indicating the presence of inflammation in association with diabetes mellitus. Analysis of the receiver operating characteristic curve showed that at a cut-off value of 2.83, NLR can detect DVT in diabetic patients with 67% sensitivity and 92% specificity. Similarly, PLR at a cut-off value of 131.46 can detect DVT in diabetic patients with 56% sensitivity and 90% specificity. Conclusions We conclude that NLR and PLR are novel inflammatory markers that can help in the early detection of DVT in diabetic patients.

Assessment of Risk Factors and Risk Stratification for Venous Thromboembolism (VTE) in Pregnancy: A Study Conducted in A Tertiary Level Hospital

Background: Pregnancy itself is one of the most provoking factors for the development of venous thromboembolism (VTE) with an incidence of 5-12 per 10 000 pregnancies (from conception to delivery, i.e., 40 weeks) and 3-7 per 10 000 deliveries postpartum (6 weeks).1 Moreover, certain clinical conditions and individual patient profile make each pregnant women more susceptible to develop symptomatic VTE comprising deep vein thrombosis (DVT) and pulmonary embolism (PE). There is no denial of the fact that risk stratification based upon individual risk factors (both clinical and biochemical) during antenatal period will rationalize the implementation of precise antenatal care/ personalized prophylaxis tailored to each pregnant women, ultimately leading to safe and healthy maternal and perinatal outcome. Objective: The objective of this study is to apply the documented assessment scoring system according to the RCOG Guideline 37a mainly based on clinical risk factors to detect and stratify antenatal patient risk of VTE and institute appropriate preventive treatment/advice. Method: This is a prospective cross-sectional study involving 50 antenatal/pregnant women randomly selected over a period of 6 months undergoing antenatal care in Bangladesh Medical College. For the assessment of risk of VTE in these patients, RCOG guideline 37a risk assessment tool was used. (Appendix 1) A score ranging from 0 to 4 or more was objectively found among these patients. Based upon the score, each patient was categorized as high risk, intermediate risk, and lower risk. Then thromboprophylaxis with LMWH (Enoxaparin)/mobilization was advised for variable durations depending upon the timing of presentation and scores. The patients were reassessed after admission and post-delivery using the same tool for change in transient factors and advised according to the score. Implementation of this risk stratification tool resulted in improved patient care and counselling; the pregnancy outcome of each case was followed up. Results: Among the fifty antenatal patients, RCOG guideline 37a risk assessment tool revealed the following scores: one patient scored zero. Eighteen patients scored one. Sixteen patients scored two. Nine patients scored three. Six patients scored four. Those who scored 0 and 1 (19 patients) required no thromboprophylaxis. The sixteen patients with a score of two were advised for post-natal thromboprophylaxis with low molecular weight heparin/ Enoxaparin (LMWH) for 10 days. They were reassessed/ re-scored in the postnatal period for VTE risk and 5 of these patients down scored to one. Thereby they were judged as not to require post-natal thromboprophylaxis and were advised early mobilization and avoidance of dehydration. The remaining 11 patients with a score of two on postnatal review were put on LMWH (Enoxaparin) at a dose of 20 mg daily subcutaneous (s.c.) (&lt;50 kg), 40 mg daily (50-90 kg), 60 mg daily in 2 divided dose (91-130 kg) for 10 days. Conclusion: Pulmonary embolism is a dreaded consequence of VTE in pregnancy and post-partum, resulting in sudden severe maternal morbidity and mortality. Individualized scoring of the risk of VTE or early detection of DVT (deep venous thrombosis) with subsequent treatment /prophylaxis can reduce /eliminate the risk of maternal death related to VTE. Implementation of risk stratification for VTE of antenatal patients has resulted in a change of practice emphasising preventive measures such as mobilisation and anticoagulation according to the objective scoring system. It is clear that the antepartum and postpartum periods have different magnitudes of risk and distinct risk factors for VTE and therefore must be considered separately. As a continuum of care, carefully reviewed post-partum risk factors has also been proposed by the RCOG in the GTG 37a guideline. Low-molecular-weight heparin is safe in pregnancy and post-partum in prophylactic and therapeutic doses and does not require coagulation monitoring by haematological studies. LMW heparin provides advantages over heparin in that it has better bioavailability and longer half-life, simplified dosing, predictable anticoagulant response, lower risk of Heparin induced thrombocytopenia (HIT), and lower risk of osteoporosis. However, if monitoring is necessary particularly in case of ?Class II Obesity, renal insufficiency and presence of mechanical heart valves, anti–factor Xa levels must be measured because LMWH preparations have little effect on activated partial Thromboplastin Time (aPTT).

Preoperative incidence and risk factors of deep vein thrombosis in Japanese patients undergoing total hip arthroplasty.

Preoperative deep vein thrombosis (DVT) is a risk factor for postoperative venous thromboembolism (VTE), causing severe mortality. Early detection of preoperative DVT is essential to prevent postoperative VTE. However, little is known regarding preoperative DVT in patients undergoing major surgery. The present study aimed to determine the incidence and risk factors of preoperative DVT in patients admitted for total hip arthroplasty (THA). From August 2017 to September 2022, 243 patients admitted for THA at our institution were enrolled in this study. Patients medical records and preoperative laboratory data were retrospectively collected. According to the results of lower-limb ultrasonography, patients were divided into either the non-DVT (n = 136) or DVT (n = 43) group. The incidence of DVT and independent risk factors for preoperative DVT were investigated using univariate and multivariate logistic regression analyses. The mean age was 74.0 ± 8.4years. Preoperative DVT was diagnosed in 43 of the 243 (17.7%) patients. The risk of DVT was significantly high (p < 0.05) in patients with advanced age, increased D-dimer levels, and malnutrition status, as assessed by the Geriatric Nutritional Risk Index (GNRI). Multivariate analysis showed that advanced age, increased D-dimer level, and malnutrition status assessed by the GNRI were independent risk factors for preoperative DVT. A high incidence of preoperative DVT was observed in patients undergoing THA. Advanced age, increased D-dimer levels, and malnutrition assessed by the GNRI increased the risk of preoperative DVT. Screening high-risk subgroups for preoperative DVT is necessary to prevent postoperative VTE.

The impact of fever as a testing indication on the detection rate of deep vein thrombosis in neurocritically ill patients.

Deep vein thrombosis (DVT) is considered a possible source of non-infectious, non-central fever in the intensive care unit (ICU). In the neurocritically ill, it is unknown whether lower extremity venous Doppler ultrasonography (LEVDUS) for DVT in the setting of fever leads to a higher detection rate than the baseline detection rate of DVT in this population. The aim of this study was to compare the DVT detection rate of LEVDUS performed for the indication of fever to LEVDUS performed for other indications in a neurosciences ICU. Requisition forms for all LEVDUS performed in a referral neurosciences ICU were reviewed and separated into those with "fever" as the stated reason for request and those with other stated reasons. The DVT detection rate was compared between these two categories of indications. Five hundred eleven LEVDUS were analyzed, of which 422 had been ordered for indications other than fever. Sixteen of these tests were positive, a detection rate of 3.8%. The remaining 89 LEVDUS had "fever" as the ordering indication. Six of these tests were positive for DVT, a detection rate of 6.7%. The likelihood of positivity of a test obtained as part of fever evaluation relative to one obtained for non-fever indications was not significantly different (OR, 1.83; 95% CI, 0.570-5.11; P = 0.246). LEVDUS triggered by fever detected DVT at a numerically, but not statistically significantly higher rate than did LEVDUS performed for other indications in a neurocritically ill population. More rigorous investigation of this question is needed.

Comparison of the predictive power of the 2005 and 2010 Caprini risk assessment models for deep vein thrombosis in Chinese orthopedic patients at admission: A prospective cohort study

IntroductionSeveral DVT risk assessment tools have been developed and validated to stratify the patients. The 2005 and 2010 Caprini risk assessment models (RAMs) proved reliable in detecting deep vein thrombosis (DVT) and are widely used worldwide. Although the 2010 version was recently modified, the 2005 version is still more exact and popular in the surgical population. This study aimed to compare the predictive power of the 2005 and 2010 Caprini RAMs in Chinese orthopedic patients at admission and describe the incidence of DVT during hospitalization. Study designThis prospective cohort study involved 2733 patients from the Arthritis Clinic and Research Center, Orthopedics and Traumatology Department, Orthopedic Oncology Department, and Spinal Surgery Department of Peking University People's Hospital from September 2018 to January 2019. The DVT risk scores and levels were determined for all patients using the 2005 and 2010 Caprini RAMs at admission. The sensitivity and specificity of the two tools were calculated. The patients were divided into the screened and unscreened groups according to whether or not a Doppler ultrasound (DUS) was performed. Depending upon the DUS results, the patients were divided into the DVT and non-DVT groups. The receiver operation characteristic (ROC) curve and the area under the curve (AUC) were evaluated to compare the predictive power. ResultsEighty-four patients had DVT in the four orthopedic departments, and the incidence of DVT was 3.1 %–17.2 %. The scores between the 2005 and 2010 Caprini RAMs differed (P < 0.001) among orthopedic patients at admission. Among DVT patients, the highest-risk patients accounted for 63.5 % and 52.9 % based on the 2005 and 2010 Caprini RAMs, respectively. The AUCs of the 2005 and 1020 Caprini RAMs were 0.669 ± 0.030 and 0.648 ± 0.032, respectively. There were no significant differences between the two ROC curves (P = 0.164). ConclusionThe 2005 and 2010 Caprini RAMs showed a similar predictive power in detecting DVT, but neither met the high sensitivity criteria for screening DVT in orthopedic patients. The incidence of DVT in orthopedic patients was relatively high during hospitalization.

Assessment of Deep Vein Thrombosis Using Multidetector Computed Tomography After Arthroplasty: A Retrospective Comparative Study with Doppler Sonography

Purpose: The purpose of this retrospective study was to compare the ability of indirect 128-row multidetector CT (MDCT) venography and doppler sonography to detect deep vein thrombosis (DVT) after knee or hip arthroplasty. Methods and Materials: Replacement surgery was performed on a total of ten hip and sixty-eight knee joints in 52 patients. The evaluation of the presence of DVT is degraded by the beam hardening artifact; therefore, Axial CT images could not be used to assess DVT. The beam hardening artifact's z-axis length was measured. Deep vein thrombosis was studied to see how common it is and where it occurs. The CT venograms' diagnostic performance was assessed and compared to that of the gold standard diagnostic reference for DVT: doppler sonography. Results: The beam hardening artifact had a z-axis length of 6.0 (mean standard deviation). Doppler sonography is a technique that allows you to see what's going on inside your body. In 30/52 individuals, DVT was found in the calf veins (58 percent of total population). The binary scale diagnostic test revealed that CT venography and doppler sonography had sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 93.33 percent, 90.91 percent, 90.91 percent, and 92.31 percent, respectively. Conclusion: For the aim of evaluating post-arthroplasty patients, CT venography can be utilized as a substitute for doppler sonography.

Catheter-associated deep vein thrombosis in children with severe traumatic brain injury: A single-center experience.

This study was performed to describe the single-center experience of deep vein thrombosis (DVT) in children with severe traumatic brain injury (sTBI) who were mechanically ventilated with a central line, and to identify potentially modifiable risk factors. It was hypothesized that children with DVT would have a longer duration of central venous line (CVL) and a higher use of hypertonic saline (HTS) compared to those without DVT. This was a retrospective study of children (0-18years) with sTBI, who were intubated, had a CVL, and a minimum intensive care unit (ICU) stay of 3days. Children were analyzed by the presence or absence of DVT. HTS use was evaluated using milliliter per kilogram (ml/kg) of 3% equivalents. Univariable and multivariable logistic regression models were used to determine which factors were associated with DVT. Seventy-seven children met inclusion criteria, 23 (29.9%) had a DVT detected in an extremity. On univariable analysis, children with DVT identified in an extremity had prolonged CVL use (14 vs. 8.5days, p=.021) and longer duration of mechanical ventilation (15 vs. 10days, p=.013). HTS 3% equivalent ml/kg was not different between groups. On multivariable analysis, mechanical ventilation duration was associated with DVT detection in an extremity, whereas neither CVL duration nor HTS use had an association. There was a high incidence of extremity DVT detected in children with sTBI who received invasive mechanical ventilation and had a CVL. HTS administration was not associated with DVT detection in an extremity.

ROLE OF COLOUR DOPPLER STUDY FOR EVALUATION OF LOWER LIMB DEEP VEIN THROMBOSIS

Introduction- Deep vein thrombosis is a common clinical problem. It can endanger life of a person by producing pulmonary embolism and may cause venous hypertension. and chronic venous insufciency. Evaluation of patients wi Aim- th suspected deep vein thrombosis by using color Doppler ultrasonography. After obtaining clearance from Institute's ethical commit Method- tee, all the patients fullling the inclusion criteria were selected and written consent is obtained. They will be investigated with color Doppler using GE logic P9 and P5 ultrasound machine's high frequency linear transducer. The protocol begins with the patient in supine position from upper thigh till foot with longitudinal and transverse scanning to examine the veins from the common iliac veins down to calf veins. Results- In our study 50 patients with clinically suspicion of lower limb deep vein thrombosis were subjected for Doppler examination. Out of all the patients the maximum incidences of deep vein thrombosis were noted in the age group of 31-50 yrs. i.e. 48%, and minimum incidence in the age group of 11-30 yrs. i.e. 14%. The age group of 51-70 yrs. had 22% of patients and that of 71-90 yrs. of age group had 16% of patients out of total patients in the study. Out of all the patients it was found that majority of the patients were male 78% while incidence in female patients is 22%. Out of 50 suspected patients of deep vein thrombosis 60% of them were found to be positive or presence of deep vein thrombosis and 40% of them had negative or absence of deep vein thrombosis.Deep vein thrombosis was more common in right extremity i.e. 50% then left extremity i.e. 46%. Only 4% of patients had bilateral involvement. Deep vein Conclusionthrombosis of lower limbs can be detected reliably, non-invasively and rapidly by the use of colour doppler ultrasonography. Gray scale ndings together with colour doppler helps in qualitative evaluation of the venous system of lower limbs and early detection of deep vein thrombosis in clinically suspected Thus it can be concluded that keeping in mind the limitations. and the advantages offered by the colour doppler ultrasonography, it is a good, reliable, inexpensive and rapid method of investigation for deep vein thrombosis of lower limbs.

Interventions for preventing venous thromboembolism in adults undergoing knee arthroscopy.

Interventions for preventing venous thromboembolism in adults undergoing knee arthroscopy.

A retrospective study of the role of preoperative ultrasonography in the detection of deep vein thrombosis in 1750 patients with gastric and colorectal cancers

BackgroundThere has been a lack of research in the past on the prevalence and risk factors associated with deep vein thrombosis (DVT) in patients with resectable gastric and colorectal cancers. The purpose of this study was to review the anatomical distribution, prevalence and risk factors associated with lower limb DVT in 1750 patients with preoperative gastric and colorectal cancers and to evaluate the role of preoperative ultrasonography in the detection of DVT in preventing postoperative pulmonary thromboembolism (PTE) in patients with gastric and colorectal cancers. MethodsA total of 1750 patients with gastric and colorectal cancers who underwent preoperative venous ultrasonography of the lower limbs were retrospectively reviewed. The risk factors associated with preoperative DVT were identified using univariate and multivariate logistic regression analysis. ResultsSeventy-three of the 1750 patients with gastric and colorectal cancers had DVT detected by preoperative venous ultrasonography of the lower limb and the incidence of lower limb DVT was 4.17 % in 1750 patients with gastric and colorectal cancers. Univariate analysis showed a higher risk of DVT in patients who met the following criteria: aged ≥80 years, female sex, the performance status ≥1, stage IV, ASA class ≥ III/IV, and hypertension. Multivariate logistic regression analysis showed that female sex, stage IV and ASA class ≥ III/IV were significantly associated with DVT before gastric and colorectal cancer surgery. ConclusionsOur study showed that female sex, stage IV and ASA class ≥ III/IV were significantly associated with DVT before gastric and colorectal cancer surgery. Routine venous ultrasonography for the lower limb can identify the risk of PTE, which is of great significance in the prevention and occurrence of PTE.

Routine Lower Extremity Screening Ultrasound Protocols in Trauma Patients Are Not Cost Effective.

Despite prophylaxis, deep vein thrombosis (DVT) and pulmonary embolism remain dreaded complications following traumatic injury and are associated with significant morbidity and mortality. Screening ultrasound (US) protocols have been employed in trauma centers for early detection of lower extremity (LE) deep venous thrombosis. We hypothesized that screening lower extremity venous duplex US would not prove cost effective in our trauma population who receives early pharmacologic prophylaxis. Data was collected for one year on all adult trauma patients admitted to the trauma service from December 2019 to 2020. DVT screening US was obtained at 3days after admission for patients with long bone or pelvic fracture, spinal cord injury, immobility, and/or spinal fracture requiring surgery. Screening US was obtained at 7 days for all others and repeated weekly until discharge. Data was retrospectively collected and analyzed. Exactly 1365 patients met inclusion criteria with median ISS 12 (IQR, 9-17), median age 56 (IQR, 36-73 years), and with majority blunt injuries (90.7%). A total of 1369 screening US were performed finding 27 DVTs (2%). The total cost of screening for the year analyzed amounted to over $270,000 with 50.7 screening US needed to detect 1 DVT. This resulted in an average screening cost of over $10,000 for the detection of a single DVT. In trauma patients receiving early pharmacologic prophylaxis, routine LE screening US protocols to detect LE DVT are not cost effective.

Antikoagulansi i kortikosteroidi u lečenju KOVID-19 oboljenja - šta znamo do sada?

It has been a year and a half since the fight against the COVID-19 pandemic started. In today's protocols for the treatment of COVID-19 and the prevention of its complications, corticosteroid therapy and anticoagulant therapy have a crucial part. The goal of this article is to show, based on available data, both the benefits and the disadvantages of corticosteroid and anticoagulant therapy in treating the infection caused by the Sars-CoV-2 virus. At the very onset of the pandemic, an increased frequency of thrombotic events negatively impacting the course and outcome of the disease, was registered. It has been observed that increased values of D-dimer in patients with COVID-19 do not correlate with the presence of venous thrombosis and are not reliable in the detection of deep vein thrombosis and pulmonary thromboembolism. According to the National Protocol for Treating COVID-19 (Version 12), anticoagulant therapy is recommended in hospitalized patients. Due to the risk of different side effects, such as bleeding and heparin-induced thrombocytopenia, a careful use of anticoagulant therapy is necessary, as well as close monitoring of its effects. With respect to corticosteroids, their efficacy in patients with moderate and severe clinical presentation of COVID-19, who are in need of oxygen support, was analyzed. Corticosteroids have proven efficient in decreasing mortality, decreasing the need for mechanical ventilation, decreasing the length of stay in intensive care units, as well as in shortening the length of hospital stay. Assessing the individual benefits and risks before introducing these drugs into the therapy of a patient with confirmed COVID-19 is of vital importance for achieving the desired effects of the therapy.

Convolutional neural Network-based detection of deep vein thrombosis in a low limb with light reflection rheography

Artificial intelligence has been widely used in the biomedical engineering field, which can assist the clinicians in disease diagnoses, help the engineers in physiological signal processing, or serve the people with chronic diseases in the homecare management. Blood clots in the deep veins of human body is called the deep vein thromboses (DVT). If the embolus passes through the lung, patient will have a life-threatening risk. Therefore, how to use the artificial intelligence to serve daily monitoring of the DVT condition is a valuable exploration. The light reflection rheography (LRR) has been used to detect the DVT of low limbs. In the previous study, the wearable device using LRR technique has been developed. But, this examination system could not be used by non-physician because the signal-quality evaluation of LRR and the classification of positive or negative DVT using the LRR signal all need the manual process. The goal of this study is to use a two-dimension convolutional neural network (2D CNN) to evaluate the qualities of LRR signals and classify the positive or negative DVT from the LRR signal with high reliability. The LRR signal and the smoothed signal were combined together to form a 450x450 image as the input pattern. In this study, twenty subjects were recruited to perform four-time experiments. A cuff pressured to 100 mmHg and 150 mmHg occluded the veins of low limbs to simulate the slight and serious DVT scenarios, and which was placed at the top and bottom of the knee of left leg to simulate the distal and proximal embolization. In the signal-quality evaluation, there were 700 samples including 476 high qualities and 224 low qualities, which were marked by the experts according to the vein emptying phenomenon. In the DVT classification, there were 476 samples including 167 negative samples, 158 slight positive samples, and 151 serious positive samples. A 19-layer CNN model proposed by Visual Geometry Group (VGG-19) was used in the two experiments. We performed the inter-group and intra-group analysis. Both results were better than the previous study. The accuracies of signal-quality evaluation and DVT classification were 0.92 and 0.75, respectively. Thus, the proposed method could support people with the high risk for DVT examination at non-medical settings.

The Utility of Lower Extremity Screening Duplex for the Detection of Deep Vein Thrombosis in Trauma

Trauma patients are high-risk for venous thromboembolism (VTE). Lower extremity screening duplex ultrasonography (LESDUS) is controversial and not standardized for early VTE diagnosis. By implementing risk stratification and selective screening, we aim to optimize resource utilization. A retrospective review were conducted at a Level-1 Trauma Center, January 2015-October 2019. LESDUS was performed within 72-h of presentation, then weekly. Demographics, VTE data, and outcomes were collected from the trauma registry. Risk assessment profile (RAP) score was calculated based on collected data. Of 5,645 patients included, 2,813 (49.8%) were screened for lower extremity deep vein thrombosis (LEDVT). Of 187 patients with LEDVT, 154 were diagnosed on LESDUS, 18 after negative LESDUS, and 15 in unscreened patients. Patients with VTE were older (61y versus 55, P < 0.01), more often male (70.9% versus 29.1%, P=0.03), had higher ISS (16 versus 10, P < 0.01), longer hospital length of stay (LOS) (11.5 d versus 3, P < 0.01), longer ICU LOS (4.5 d versus 1, P < 0.01), and increased mortality (9.1% versus 4.3%, P=0.01). RAP was higher in VTE patients versus those without (nine versus three, P < 0.01). RAP ≥8 was 62.5% sensitive and 70.4% specific for VTE. Chemoprophylaxis delay also correlated with increased VTE (OR=1.48, 95% CI=1.03-2.12). VTE remains a significant complication in trauma patients. Despite a universal LESDUS protocol, only 50% of patients underwent screening and 20% of all LE DVTs were not identified on LESDUS. To optimize resource utilization and protocol adherence, LESDUS should only be performed if RAP ≥8 or if unable to administer timely chemoprophylaxis.