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Abstract

Deep vein thrombosis (DVT), especially in the proximal part of the lower extremity, might progress to pulmonary embolism and be fatal. Therefore, it is crucial to prompt the diagnosis of DVT in the emergency room (ER). Due to its efficiency and patient convenience, duplex ultrasound has become the preferred diagnostic method for DVT. Point-of-care ultrasonography (POCUS) was known as a simpler and faster way to use ultrasonography at the bedside. The two-point compression method has become frequently used due to its ability to take less time for examination, yet there are still concerns about its accuracy. This study was conducted to find out whether two-point compression POCUS can be used as an early diagnostic method for proximal DVT. The literature search was carried out in the databases PUBMED, EMBASE, and SCOPUS on March 29, 2023, using keywords “Deep Vein Thrombosis”, “two-point compression POCUS”, and “diagnosis”. Four publications were chosen from the search results. One cross-sectional study was found to have a low validity value because POCUS and Doppler ultrasound operators were not blinded, and the reference test was only performed on positive DVT results on POCUS. All studies had high sensitivity and specificity (>90%) compared to the reference test, except for one cross-sectional study in critical patients in ICU, which had a 63% sensitivity value. In conclusion, the two-point compression POCUS method can be utilized as an early diagnostic method for proximal DVT, with the disclaimer that POCUS operators should get curriculum-based training before doing the examination.

Bahasa Abstract

Trombosis vena dalam atau Deep Vein Thrombosis (DVT) ekstremitas bawah, terutama pada bagian proksimal, merupakan suatu kondisi yang berpotensi berkembang menjadi emboli paru dan menjadi fatal bila tidak ditangani dengan cepat. Oleh karena itu, diagnosis DVT yang akurat dan cepat sangat penting dilakukan. Selama ini ultrasonografi dupleks menjadi pilihan modalitas utama untuk mendiagnosis DVT karena keefisienan dan kenyamanan bagi pasien. Metode point-of-care ultrasound (POCUS) dikembangkan sebagai metode penggunaan ultrasonografi yang lebih sederhana dan cepat agar dapat dilakukan secara bedside. Di antara metode POCUS, metode two-point compression POCUS seringkali dipakai karena dalam pemeriksaannya memerlukan waktu yang lebih singkat, tetapi keakuratannya masih menjadi pertanyaan. Penelitian ini dilakukan untuk mengetahui apakah two-point compression POCUS dapat digunakan sebagai metode diagnosis dini pada DVT proksimal. Pencarian literatur dilakukan pada database PubMed, Embase, dan Scopus pada tanggal 29 Maret 2023 dengan menggunakan kata kunci sesuai dengan pertanyaan klinis yaitu “Deep Vein Thrombosis (DVT)”, “two-point compression POCUS”, dan “diagnosis”. Hasilnya didapatkan 4 artikel terpilih. Satu artikel studi potong lintang ditemukan memiliki nilai validitas rendah karena tidak diketahui dilakukan blinding antar-operator POCUS dengan operator USG Doppler dan reference test hanya dilakukan pada hasil positif DVT pada POCUS. Semua artikel melaporkan sensitivitas dan spesifitas tinggi (>90%) dibandingkan reference test kecuali 1 studi potong lintang pada pasien critical care di ICU yang melaporkan sensitivitas 63%. Two-point compression POCUS dapat digunakan sebagai metode dini pada DVT proksimal dengan catatan bahwa operator POCUS sebaiknya diberi pelatihan yang terstandardisasi sesuai kurikulum sebelum melakukan pemeriksaan.

Kata Kunci: deep vein thrombosis, diagnosis, ekstremitas bawah, POCUS, two-point compression ultrasonography

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