ArticleThe western journal of emergency medicine2016
Mistakes and Pitfalls Associated with Two-Point Compression Ultrasound for Deep Vein Thrombosis.
Article in The western journal of emergency medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Ultrasound Performed by Emergency Physicians for Deep Vein Thrombosis: A Systematic Review.The western journal of emergency medicine · 2024Pooled it
- Pooled it
- Quantitative Compression Ultrasound via a Force-Area Digital Twin for Mechanistic Assessment of Venous Thrombosis.Annals of biomedical engineering · 2026Article
- Positioning Statement on the Use of Point-of-Care Ultrasound in Cardiovascular Medicine - 2026.Arquivos brasileiros de cardiologia · 2026Article
- Deep venous thrombosis (DVT) diagnostics: gleaning insights from point-of-care ultrasound (PoCUS) techniques in emergencies: a systematic review and meta-analysis.The ultrasound journal · 2024Review
- Review
- The Use of Point-of-Care Ultrasound (POCUS) in the Diagnosis of Deep Vein Thrombosis.Journal of clinical medicine · 2021Review
- Prevalence and predictors of alternative diagnoses on whole-leg ultrasound negative for acute deep venous thrombosis.BMC medical imaging · 2020Article
- Accuracy of three-point compression ultrasound for the diagnosis of proximal deep-vein thrombosis in emergency department.Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences · 2019Article
- Global Ultrasound Check for the Critically lll (GUCCI)-a new systematized protocol unifying point-of-care ultrasound in critically ill patients based on clinical presentation.Open access emergency medicine : OAEM · 2019Article
- The utility of superb microvascular imaging for the detection of deep vein thrombosis.Journal of medical ultrasonics (2001) · 2018Article
- Comparison between two-point and three-point compression ultrasound for the diagnosis of deep vein thrombosis.Journal of thrombosis and thrombolysis · 2018Article
- An overview of point-of-care ultrasound for soft tissue and musculoskeletal applications in the emergency department.Journal of intensive care · 2016Review
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionTwo-point compression ultrasound is purportedly a simple and accurate means to diagnose proximal lower extremity deep vein thrombosis (DVT), but the pitfalls of this technique have not been fully elucidated. The objective of this study is to determine the accuracy of emergency medicine resident-performed two-point compression ultrasound, and to determine what technical errors are commonly made by novice ultrasonographers using this technique.
methodsThis was a prospective diagnostic test assessment of a convenience sample of adult emergency department (ED) patients suspected of having a lower extremity DVT. After brief training on the technique, residents performed two-point compression ultrasounds on enrolled patients. Subsequently a radiology department ultrasound was performed and used as the gold standard. Residents were instructed to save videos of their ultrasounds for technical analysis.
resultsOverall, 288 two-point compression ultrasound studies were performed. There were 28 cases that were deemed to be positive for DVT by radiology ultrasound. Among these 28, 16 were identified by the residents with two-point compression. Among the 260 cases deemed to be negative for DVT by radiology ultrasound, 10 were thought to be positive by the residents using two-point compression. This led to a sensitivity of 57.1% (95% CI [38.8-75.5]) and a specificity of 96.1% (95% CI [93.8-98.5]) for resident-performed two-point compression ultrasound. This corresponds to a positive predictive value of 61.5% (95% CI [42.8-80.2]) and a negative predictive value of 95.4% (95% CI [92.9-98.0]). The positive likelihood ratio is 14.9 (95% CI [7.5-29.5]) and the negative likelihood ratio is 0.45 (95% CI [0.29-0.68]). Video analysis revealed that in four cases the resident did not identify a DVT because the thrombus was isolated to the superior femoral vein (SFV), which is not evaluated by two-point compression. Moreover, the video analysis revealed that the most common mistake made by the residents was inadequate visualization of the popliteal vein.
conclusionTwo-point compression ultrasound does not identify isolated SFV thrombi, which reduces its sensitivity. Moreover, this technique may be more difficult than previously reported, in part because novice ultrasonographers have difficulty properly assessing the popliteal vein.
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