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A Systematic Review

Bisher O. Mustafa, MD; Suman W. Rathbun, MD; Thomas L. Whitsett, MD; Gary E. Raskob, PhD

Arch Intern Med. 2002;162:401-404.

Objectives  To determine the sensitivity and specificity of ultrasonography in the diagnosis of upper extremity deep vein thrombosis and to determine the safety of withholding anticoagulant therapy in patients with negative ultrasonographic results.

Data Sources  The MEDLINE database was searched for literature published from January 1, 1980, to December 31, 2000, that evaluated ultrasonography for the diagnosis of upper extremity deep vein thrombosis. Bibliographies of the retrieved articles were cross-checked to identify additional studies.

Study Selection  All prospective English-language studies were selected. Retrospective studies, review articles, and case reports were excluded.

Data Extraction  Two of us (B.O.M. and S.W.R.) used predefined criteria to independently assess each study. Data on sensitivity and specificity and the associated 95% confidence intervals were recorded when available.

Data Synthesis  Only one study met all of the predefined criteria for adequately evaluating sensitivity and specificity. The sensitivity of duplex ultrasonography ranged from 56% to 100%, and the specificity ranged from 94% to 100%. No study evaluated the safety of withholding anticoagulant therapy without additional testing in patients with negative ultrasonographic results.

Conclusion  The safety of withholding anticoagulant treatment in a patient with suspected upper extremity deep vein thrombosis and negative ultrasonographic results is uncertain.

From the Departments of Medicine (Drs Mustafa, Rathbun, Whitsett, and Raskob) and Biostatistics and Epidemiology (Dr Raskob), The University of Oklahoma Health Sciences Center, and Veterans Administration Medical Center, Oklahoma City.

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