Randomized prospective study comparing routine versus selective use of sonography of the complete calf in patients with suspected deep venous thrombosis.

OBJECTIVE: We compared patient outcomes using two protocols: one routinely and the other selectively evaluating the calves completely during sonographic assessment of the lower extremities in patients with suspected deep venous thrombosis. SUBJECTS AND METHODS: In this randomized prospective study, patients were assigned to two groups. In one group, the deep calf veins were routinely evaluated in their entirety, and in the other group the calf was not evaluated unless the patient had symptoms or physical signs in the calf, in which case only the areas of symptoms or physical signs were evaluated. Patients were followed up for 3 months by medical record review, physician surveys, and telephone calls. An adverse outcome was a propagated deep venous thrombosis into the thigh or a pulmonary embolus. Examination times were recorded when possible. RESULTS: Of the 235 patients in the group in which the deep calf veins were routinely evaluated, we saw no adverse outcomes (0.0%; 97.5% one-sided confidence interval [CI], 0.6-1.6%). Of the 261 patients in the group in which the calf was only evaluated if there were signs or symptoms, we saw two adverse outcomes (0.8%; 95% CI, 0.1-2.7%). CONCLUSION: We found no significant difference in adverse outcomes in patients undergoing a protocol in which the deep calf veins were routinely evaluated or a protocol in which the calf was evaluated only if physical signs or symptoms were present.

CT in detecting urinary tract calculi: influence on patient imaging and clinical outcomes.

PURPOSE: To determine changes in examination patterns and effectiveness of care since the introduction of unenhanced helical computed tomography (CT) for examination of patients presenting to the emergency department (ED) with symptoms of urinary tract calculi (UTC). MATERIALS AND METHODS: Hospital clinical and radiology information systems were used to retrospectively identify patients presenting with UTC symptoms from January to December 1997 (before introduction of unenhanced CT) and from January to December 1999 (after introduction of unenhanced CT). Chart abstraction was used to confirm the identification of patients with presenting symptoms suggestive of UTC and assess patient outcomes. Two hundred sixty-five patients presented before (1997) and 602 after (1999) unenhanced CT was introduced. Distributions of dichotomous variables were compared between the 1997 and 1999 groups by using logistic regression. Means were compared between the groups by using analysis of variance and mean total numbers of imaging studies by using Poisson regression. RESULTS: Total number of imaging studies increased by 26.7% per patient visit (P <.001). Rates of admission following the initial ED visit (13.7% in 1997 vs 13.4% in 1999), as well as percentage of patients who subsequently returned to the ED (12.0% in 1997 vs 13.7% in 1999) or subsequently were admitted to the hospital (4.5% in 1997 vs 5.3% in 1999) in the month following the initial ED visit, were similar between the two groups. Unsuspected unenhanced CT findings that could affect acute patient care were observed at 5.9% of examinations. CONCLUSION: Use of imaging for suspected UTC has increased markedly since the introduction of unenhanced CT, with little effect on acute care of patients in the ED.