Value of venous color flow duplex scan as initial screening test for geriatric inpatients with clinically suspected pulmonary embolism

Raghid Kreidy¹, Elias Stephan², Pascale Salameh³, Mirna Waked^4
1Department of Vascular Surgery, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon; ²Department of Geriatrics, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon; ³Laboratory of Clinical and Epidemiological Research, Faculty of Pharmacy, Lebanese University, ⁴Department of Pulmonary Medicine, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon

Aim: The contribution of lower extremity venous duplex scan to the diagnostic strategy for pulmonary embolism has been demonstrated by many authors. However, the positive diagnostic value of this noninvasive test in clinically suspected pulmonary embolism is not very high (10%–18%). Since thromboembolic risks increase considerably in hospitalized patients with advanced age, this study aims to determine the importance of lower extremity venous color flow duplex scan in this particular subgroup of patients with clinically suspected pulmonary embolism. The effects of clinical presentation and risk factors on the results of duplex scan have been also studied.
Methods: Between July 2007 and January 2010, 95 consecutive Lebanese geriatric ($60 years of age) inpatients with clinically suspected pulmonary embolism assessed in an academic tertiary-care center for complete lower extremity venous color flow duplex scan were retrospectively reviewed. Age varied between 60 and 96 years (mean, 79.9 years). Forty patients were males and 55 females. Absence of compressibility was the most important criteria for detecting acute venous thrombosis.
Results: Out of 95 patients, 33 patients (34.7%) were diagnosed with recent deep venous thrombosis of lower extremities (14 proximal and 19 distal) using complete venous ultrasound. Nine of these 33 patients (27.2%) had a history of venous thromboembolism and eleven (33.3%) presented with edema of lower extremities. A total of 28 patients (84.8%) with positive duplex scan had associated risk factors for venous thromboembolism.
Conclusion: Lower extremity venous color flow duplex scan appears to be a reasonable initial screening test in the diagnostic algorithm of pulmonary embolism in geriatric inpatients with clinically suspected pulmonary embolism. This is particularly true in patients with a history of venous thromboembolism, in patients with a clinical presentation suggesting venous thrombosis, in uremic patients and in patients with altered general and mental status who are not candidates for chest computed tomography.

Keywords: venous thrombosis, lower extremities, geriatric