14 Jul Ultrasonographic Evaluation Of Deep Venous Thrombosis By Medical Students.
José Pazeli Jr, Marcus Bastos, Ana Luisa Vieira, Flávio Martins, Pedro Pires, Pedro Oliveira Neto, Mozart Gomes Neto, Fábio Mendes Filho
To demonstrate that medical students naive in ultrasound (US) knowledge are able to diagnose Deep Venous Thrombosis, after minimal training.
Deep venous thrombosis (DVT) is a frequent pathology with associated high morbidity and mortality.
A rapid and accurate diagnosis is essential for patient care.
Doppler ultrasonography is a standard in diagnosis of deep vein thrombosis.
This evaluation is traditionally performed and interpreted by board-certified radiologists or vascular specialists.
However, delays in performance and interpretation of the comprehensive study are common, especially in developing countries with little availability of these specialized professionals.
Point-of-care focused vascular sonography (POCVS), performed by intensivists and emergencists, has proven to accurately diagnose DVT in the ambulatory and emergency room settings.
Whether trained medical students can perform quality POCVS is unknown
Four medical students, with no prior US experience, underwent a four hours theoretical and practical training in US focused on deep venous system of the lower limbs.
The course included training of the compression ultrasonography (CUS) which is a high sensitive and specific modality for the recognition of lower DVTs. To detect proximal lower-extremity DVTS, the students were trained to use a modified 2-point CUS that focuses on the highest probability areas (common femoral region and the popliteal fossa), decreases the study time, and provides similar sensitivity and specificity.
After completing their training, the students evaluated subjects with or without DVT who were previously examined and selected by an intensivist and a vascular surgeon, both with a vast experience on US. The students did not have access to the clinical information and the previous results of the vascular evaluations of the patients.
Sample: Outpatients and inpatients subjects of both sexes, aged between 16 and 76 years, were included in the study. Statistic: The existence of a relationship between the studied variables was determined by Fisher’s Exact Test.
Accuracy, sensitivity, specificity, positive predictive value, negative predictive value and their respective confidence intervals were calculated.
Thirty-five patients were evaluated, of which seven presented compatible readings for DVT and 28 were not compatible.
The study showed a sensitivity of 100%, specificity of 96.6% and accuracy of 97.1%.
The training of medical students to recognize DVT is a simple, quick, and feasible task and that can be integrated into the undergraduate medical curriculum.