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Appropriateness of Repeat US Doppler Requests for DVT
Poster Title: Appropriateness of Repeat US Doppler Requests for DVT
Submitted on 13 Sep 2018
Author(s): Dr Bahareh Gholipour, Dr Madiha Hussain, Adshara Vimalanathan
Affiliations: Radiology Department, Whittington Hospital, Whittington Health NHS Trust
This poster was presented at BIR 2018
Poster Views: 614
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Poster Information
Abstract: Title: Appropriateness of Repeat US Doppler Requests for DVT.

Background: NICE guidelines state that repeat DVT scans are only indicated in cases of high clinical suspicion (Wells score >1) with a normal initial scan and a subsequent raised D-dimer. In our department, a rising number of repeat Doppler scan requests were noted with a suspected low positive yield. An audit was therefore performed to determine whether the guidelines are being followed (i.e. appropriate requests) and to identify the positive detection rate in repeat scans.

Standards & Targets: RCR (1) and NICE guidelines (2) state that 100% of the requests should document the Wells score (+/-D-dimer) in appropriate referrals. Systematic review (3) on diagnostic yield of repeat scans suggest a positive detection rate of at least 15%.

Methodology: 50 patients who had a repeat US doppler were identified using PACS. The following data was collected: Appropriateness of requests - i.e. Inclusion of Wells Score (+/- D-dimer) on request forms and presence of DVT on repeat doppler reports.

Results: Overall only 11 requests (22%) documented the Wells score (only 8 of which had a score >1). Only 4 repeat scans (8%) were positive for DVT.

Conclusion: Standards are currently not being met - thought to be secondary to low awareness of guidelines, given the lack of suitable requests. We therefore plan to raise awareness through junior doctor teaching and by posting NICE algorithm posters in clinical environments and creating a mandatory section on DVT request forms (Wells score +/- D-dimer) with a re-audit in 6 months to assess impact of the changes made.
Summary: Appropriateness of repeat US doppler requests for the investigation of DVT and local positive detection rate.References: 1. RCR Guidelines:
2. NICE Guidelines: CG144 Venous thromboembolic diseases (2012 updated 2015)
3. Goodacre S, Sampson F, Thomas S, van Beek E, Sutton A. Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis. BMC medical imaging. 2005;5(1):6.
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