Is contrast venography still the gold standard in diagnosis of lower limb deep vein thrombosis?

Pettitt, Jonathan (2009) Is contrast venography still the gold standard in diagnosis of lower limb deep vein thrombosis? BSc dissertation, University of Portsmouth.

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    Aim: To assess if contrast venography can still be considered the gold standard in the diagnosis of lower limb deep vein thrombosis. Method: A literature review was decided on as the best way of meeting the aim of the project. A systematic search of the literature was conducted using search engines, bibliographic databases and electronic journals as well as hand searching of NHS trust libraries and the University of Portsmouth Library. Literature was excluded using exclusion criteria. Papers regarding the accuracy of different diagnostic tests for the diagnosis of lower limb DVT were included as well as papers regarding tests availability and cost. The papers were critically evaluated for bias. Results were compared and discussed. Conclusions and recommendations were made. Results: A large number of prospective studies comparing ultrasound to venography found ultrasound to have consistently high sensitivity and specificity for detection of proximal lower limb DVT, studies found a decrease in sensitivity and specificity for distal lower limb DVT. Studies of computed tomography venography (CTV) showed a wide range of reported sensitivities from 71-100%. Variation in protocols of studies was thought to explain this variation. D-dimer tests were found to have high sensitivities and low specificities, so could be used as exclusion test in conjunction with clinical assessment scores but not for the confirmation of DVT. There was found to be a lack of enough large enough studies on the accuracy of MRI in the diagnosis of DVT to consider it an accurate test. Strain Gauge plethysomgraphy had lower specificities as with D-dimer test and could not be used for diagnosis of DVT. It was found that the most widely available diagnostic tests were ultrasound and D-dimer. Combinations of tests decided by algorithms are widely used to reduce costs, with venography used sparingly in these algorithms. Conclusion: The review found contrast venography to still be the gold standard for DVT diagnosis of the lower limb in regards to accuracy; it also found that ultrasound in conjunction with D-dimer tests as an algorithm can be considered a new gold standard. The review proposes that diagnosis of DVT should now be viewed in terms of diagnostic algorithms rather than a single definitive test. The study identified a need for further research as to the accuracy of MRI and ultrasound for distal DVT with current ultrasound equipment. The review also recommends a national guideline to be produced on the best possible diagnostic algorithms for diagnosis of lower limb DVT.

    Item Type: Dissertation
    Departments/Research Groups: Faculty of Science > School of Health Sciences and Social Work
    Depositing User: Jane Polwin
    Date Deposited: 20 Jan 2011 12:48
    Last Modified: 28 Jan 2015 11:14

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