Background: Point of Care Ultrasound have reported a sensitivity of 96.1% and specificity of 96.8% by Emergency Physicians (EP) for the detection of proximal deep vein thrombosis (PDVT). However, the method of training, learning and practice necessary to perform a correct examination is not well defined, ranging from 10 minutes to 48 hrs. The purpose of this study is to evaluate a concise blended-learning methodology to teach an Extended Upper Leg Compressible (EULC) Technique for the diagnosis of PDVT.
Methods: A prospective cross-sectional study was conducted in the Emergency Department (ED) of an academic medical center in Santiago, Chile. 27 EP and residents were trained in EULC technique with Blended-Learning Methodology consisting of a 30 minute online video lecture and a 90 minute hands-on session. After training, 101 patients with suspected DVT that visited the Emergency Department where recruited. Exclusion criteria where known DVT with or without anticoagulant treatment and impossibility to have a comprehensive doppler study by the Radiology Department (RD) which was used as Gold Standard. EP participating on the study where blinded to the pretest probability for DVT.
Results: 3 patients were unable to determine if vein compression was positive or not. For purpose of the study these were taken as positive. 17 (16.8%) patients had a PDVT and 8 (7.9%) had distal DVT, which for the purposes of the results were considered negative for PDVT, because they were outside the examined area.
After training, EP with little experience, achieved a sensitivity of 100% (95% CI 81.4-100) and specificity of 90.3% (95% CI 81.8-95.75) for diagnosis of PDVT. EP correctly identified the 17 patients who were diagnosed as PDVT, however there were 5 positive exams that weren't consistent with the ones performed by the RD.
Conclusion: With this minimum training, a good correlation is achieved compared with RD doppler exams. Our data suggest that a thorough training is not necessary to achieve competence in this technique and that with this minimum training, any EP is able to easily identify a PDVT.