This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (44)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Jeffrey S. Ginsberg, MD; Phillip S. Wells, MD; Jack Hirsh, MD; Akbar A. Panju, MB; M. Ameen Patel, MD; Dermott E. Malone, MB; Joanne McGinnis, RN; Pamela Stevens, RN; Patrick Brill-Edwards, MD

Arch Intern Med. 1994;154(17):1930-1933.

Abstract
Background
To reevaluate the sensitivity of impedance plethysmography (IPG) for proximal deep vein thrombosis (DVT) and to establish a relationship between the location and size of thrombi and the results of IPG.

Design
Prospective cohort study.

Methods
One hundred thirty-two consecutive patients with clinically suspected DVT underwent IPG testing and most (n=118) underwent contrast-enhanced venography; in 14 patients, venous ultrasonography was performed and demonstrated definitive proximal DVT in which the size and extent of the thrombus could be delineated. All patients with dubious or normal ultrasound results underwent contrast-enhanced venography. All tests were performed and test results were interpreted without knowledge of the results of the other tests. Patients were considered to have proximal DVT if this was demonstrated on venography or ultrasound, calf DVT if this was demonstrated on venography, or no DVT if venography yielded normal findings. The sensitivity and specificity of IPG for DVT were calculated.

Results
Of the 132 patients, 40 (30%) had proximal DVT, seven (5%) had calf DVT, and 85 (64%) had no DVT. The sensitivity of IPG for proximal DVT was 65% and the specificity was 93%. Of the proximal vein thrombi, IPG detected three (23%) of 13 that involved the popliteal vein but not the superficial femoral vein and 23 (85%) of 27 proximal vein thrombi that involved the superficial femoral vein.

Conclusions
Our study demonstrated that the sensitivity of IPG for proximal DVT at our center is only 65%, a figure that is much lower than those reported in earlier studies from our institution. We hypothesize that because of a change in referral practice, an increased proportion of patients with less severe symptoms are now referred to our center than in the past. These patients have thrombi that are smaller, less likely to be occlusive, and therefore less likely to yield abnormal IPG findings.

(Arch Intern Med. 1994;154:1930-1933)

Author Affiliations
From the Departments of Medicine (Drs Ginsberg, Wells, Hirsh, Panju, Patel, and Brill-Edwards and Mss McGinnis and Stevens) and Radiology (Dr Malone), McMaster University, Hamilton, Ontario.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Meta-analysis of plethysmography and rheography in the diagnosis of deep vein thrombosis.
Locker et al.
Emerg. Med. J. 2006;23:630-635.
ABSTRACT | FULL TEXT  

Ultrasonography and Diagnosis of Venous Thromboembolism
Zierler
Circulation 2004;109:I-9-I-14.
ABSTRACT | FULL TEXT  

Guidelines on diagnosis and management of acute pulmonary embolism
Eur Heart J 2000;21:1301-1336.
 

The Diagnostic Approach to Acute Venous Thromboembolism . Clinical Practice Guideline
Tapson
Am. J. Respir. Crit. Care Med. 1999;160:1043-1066.
FULL TEXT  

Diagnostic approach to patients with suspected pulmonary embolism: a report from the real world
Saro et al.
Postgrad. Med. J. 1999;75:285-288.
ABSTRACT | FULL TEXT  

Venous thrombus stability during acute phase of therapy
Caps et al.
Vasc Med 1999;4:9-14.
ABSTRACT  

The Clinical Diagnosis of Deep Venous Thrombosis: Integrating Incidence, Risk Factors, and Symptoms and Signs
Kahn
Arch Intern Med 1998;158:2315-2323.
ABSTRACT | FULL TEXT  

Is Impedance Plethysmography a Safe Test After Total Joint Replacement?
Dixon et al.
VASC ENDOVASCULAR SURG 1998;32:255-260.
ABSTRACT  

Does This Patient Have Deep Vein Thrombosis?
Anand et al.
JAMA 1998;279:1094-1099.
ABSTRACT | FULL TEXT  

The Use of D-Dimer Testing and Impedance Plethysmographic Examination in Patients With Clinical Indications of Deep Vein Thrombosis
Ginsberg et al.
Arch Intern Med 1997;157:1077-1081.
ABSTRACT  

A Novel and Rapid Whole-Blood Assay for D-Dimer in Patients With Clinically Suspected Deep Vein Thrombosis
Wells et al.
Circulation 1995;91:2184-2187.
ABSTRACT | FULL TEXT  

Impedance Plethysmography for Suspected Deep-Vein Thrombosis
Raskob et al.
Arch Intern Med 1995;155:773-776.
ABSTRACT  

Impedance Plethysmography for Suspected Deep-Vein Thrombosis-Reply
Ginsberg et al.
Arch Intern Med 1995;155:776-776.
ABSTRACT  

MORE ON IMPEDANCE PLETHYSMOGRAPHY FOR DVT
JWatch General 1994;1994:4-4.
FULL TEXT  

Diagnostic Tests for Deep Vein Thrombosis: Clinical Usefulness Depends on Probability of Disease
Wheeler et al.
Arch Intern Med 1994;154:1921-1928.
ABSTRACT