Better adherence to guidelines can help avoid unnecessary ultrasound investigations and ER visits

Deep vein thrombosis (DVT) is a common differential diagnosis in patients with a swollen lower limb and the suggested method of investigation with pre-test probability including Wells score and D-dimer is well established. We have conducted a retrospective descriptive directory study to examine how DVT-investigations are being conducted and a retrospective cohort study to compare correctly and incorrectly investigated patients regarding missed DVT and the usage of imaging. Our study has been conducted though chart reviews of 398 patients with suspected DVT at the emergency department (ED) at Sodersjukhuset in Stockholm during 2016. A total of 74/398 cases of DVT were verified. More than half of the investigations were not conducted according to the current guidelines. These investigations did not miss any DVTs but did use significantly more imaging (86,2 % vs 49,6 %, p < 0,01). ED admissions could be avoided for approximately one out of three referred patients if stricter diagnostics were conducted by the referring doctor.