The Diagnostic Performance of a Non-Emergency Department-Based Deep Vein Thrombosis Ambulatory Care Pathway

Background

Ambulatory management of isolated acute deep vein thrombosis (DVT) is the standard of care in most patient populations, and in clinical practice is mostly initiated in the emergency department (ED). However, patients referred to the ED with suspected DVT often experience unnecessary delays to diagnosis and subsequent long stays to determine appropriate treatment and follow up care. We implemented a DVT ambulatory care pathway that does not include the ED for referred patients with suspected isolated DVT that begins with pre-test risk stratification in the community and subsequent algorithm-based diagnostic work-up, treatment, and follow-up at a tertiary care centre in Montreal Canada.

Objective

To determine the diagnostic performance of a non-ED based DVT ambulatory care pathway.

Methods

We determined the prevalence of DVT over a 46 week period between August 2018 and June 2019 among ambulatory patients with suspected isolated DVT who following community-based risk stratification using the modified Well's clinical prediction score were referred for diagnostic work up and treatment using a newly implemented non-ED based DVT ambulatory care pathway.

Results

Among 122 patients referred by community physicians, 86 (70%) met pre-defined pathway criteria for assessment of suspected DVT. In all, 42 (49%) were referred with an unlikely/low modified Well's score and 44 (51%) with a likely/high score. Overall, the prevalence of DVT was 19.8%, specifically 9.5% in the unlikely/low and 30.2% in the likely/high pretest probability groups, respectively.

Conclusion

Our results show that the diagnostic performance of a non-ED based acute DVT ambulatory care pathway is in line with literature estimates. The advantage of this pathway is that it offers clear, evidence-based guidance for community physicians to diagnosis and treat patients in an ambulatory setting without using the ED. The approach is likely to result in both healthcare and economic benefits, including increased patient satisfaction and shorter ED stays.