Analysis Examines Ultrasound Use for Blood Clots

Review suggested one scan is usually enough, but editorial begs to differ

By Ed Edelson
HealthDay Reporter

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TUESDAY, Feb. 2 (HealthDay News) -- It's unusual for a paper in a medical journal to be accompanied by an editorial saying that the conclusion reported in the paper might be "overly simple and consequently not clinically useful."

However, that is exactly what has happened in the Feb. 3 issue of the Journal of the American Medical Association.

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The paper in question, from researchers at the University of Utah, asks whether a single ultrasound exam might be enough to determine whether someone has a dangerous blood clot in a deep vein of a leg below the knee. The paper averaged the results of seven studies that included 4,731 cases, and concluded that the usual practice of doing repeat ultrasounds looking for such a deep vein thrombosis (DVT) isn't necessary.

The average risk of having a DVT in all the studies over the next three months was about one in 200, or 0.57 percent, such a low rate that the routine procedure of multiple ultrasound scans "requires further study," the report concluded, a polite way of saying that it isn't necessary.

But an accompanying editorial penned by two doctors who are consulting editors to the journal details serious doubts about that conclusion.

The reason for doubt, said editorial co-author Dr. Edward H. Livingston, who is chairman of gastrointestinal and endocrine surgery at the University of Texas Southwestern Medical Center in Dallas, is that the usual practice of lumping all the results of several studies together in a meta-analysis, and reasoning from the resulting average, doesn't work in this particular report.

One of the seven studies, which contributed nearly 25 percent of the total cases, included only ambulatory patients -- people who came to a doctor's office complaining of leg pain, Livingston said. That study, which found a thrombosis incidence of just 0.48 percent, pulled the overall results of the meta-analysis too far in one direction, he said.

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