Rheumatology: Current Research
Open Access
ISSN: 2161-1149 (Printed)
ISSN: 2161-1149 (Printed)
Ibrahim Natalwala
Scientific Tracks Abstracts: Rheumatology & Orthopedics
Background: DVT?s are well reported complications in post-operative orthopaedic patients and can result in pulmonary emboli (PE) and death. The Wells Score is used to determine the clinical probability of a DVT. Its efficacy is reduced in post-operative patients since D-dimer values are invariably high and patients frequently have unilateral leg swelling or calf tenderness. Objective: To identify the number of lower limb ultrasound scans (LLUSS) performed on Orthopaedic patients and evaluate the effectiveness of the Wells scoring system. Methods: The Radiology department at the University Hospital of North Staffordshire created an algorithm to automatically collect the results of every LLUSS requested from September 2009 to September 2011. The Wells score for each request was manually extracted from the Clinical Research Information System (CRIS). Results: 12/175 (6.9%) LLUSS were positive for DVT of which 8/12 (66.7%) were females. Mean age of sample was 69.6 years. The average Wells score for positive LLUSS was 3.67 (�1.37 SD) and for negative scans was 3.10 (�1.51) with p=0.245. ?Recent immobilisation?, ?tenderness in deep vein distribution?, ?entire leg swelling?, ?asymmetric calf swelling?, and ?pitting oedema? were frequently reported. Only ?previous history of cancer?, and ?alternative diagnosis as likely? had some positive predictive value with p=0.075 for both. Conclusions: Far too many LLUSS were requested over 2 years since only 7% were positive. This data shows it is very difficult to predict DVT?s using the Wells Score in post-operative patients. This article considers alternative predictive factors to help prevent unnecessary LLUSS and waste of resources.
Dr. Ibrahim Natalwala has completed his MBBS Medical Degree from King?s College London, UK in 2011. He has also completed a Masters Degree (MSc) in Clinical Neurosciences also from King?s College London in 2010 as an intercalated programme whilst studying Medicine. He has undertaken a prestigious Academic Primary Care/Rheumatology placement at the University Hospital of North Staffordshire, UK as part of the Foundation Training Program