Correlation of Examination and Nonexamination Factors With Ultrasound Positivity for Deep Vein Thrombosis.

Abstract

First-line imaging for diagnosis of deep vein thrombosis (DVT) is ultrasound. Although the Wells criteria and laboratory testing help inform best ordering practices, this investigation evaluates the influence of various patient and nonpatient factors on examination results. The authors analyzed structured reports from all inpatient and emergency department ultrasound examinations across two institutions from 2015 to 2022. Examination, provider, and patient factors were compared with examination results for effect on examination results and intergroup variance. The overall rate of acute or new noncalf DVT was 10.4%. Rates of acute or new noncalf DVT were found to be higher in inpatients (versus emergency department patients), in upper extremities (versus lower extremities), in patients with lower body mass index values, among physicians (versus advanced practice providers), and when examinations were ordered by providers with fewer overall DVT ultrasound examinations ordered. Mixed results were observed for number of limbs examined and provider supervision status. Examination day of week and time of day were not significant. DVT ultrasound results varied according to examination-, facility-, patient-, and provider-level factors, which can inform institutional quality monitoring programs, resource utilization, and future investigations into factors that may influence diagnostic testing results.