Abstract
Background: At Epsom and St. Helier, patients are referred to the SDEC (Same Day Emergency Care) Pathway for the organisation of an Ultrasound Doppler of their lower limbs based on their presentation to Accident and Emergency with lower limb swelling, pain, and an elevated D-Dimer. This has resulted in inundation of a dedicated ultrasound service, with wait times for scan up to 10 days.
Aim: To review the DVT Pathway of outpatient referrals to the Medical Assessment Unit (SDEC) at St. Helier Hospital, To audit the outcome of DVT referrals to the SDEC department from Accident and Emergency, and GP services.
Methodology: Data was collected retrospectively on 74 patients who were referred for DVT assessment. The information gathered included age, gender, symptoms upon presentation, D-Dimer test results, and the findings of ultrasound Doppler examinations.
Findings: On average, the patients were 64 years old, and there were 31 men and 43 women in the patient group. Out of the 74 scans performed, only 7 yielded positive results, indicating that 1 in 10 referrals led to a positive outcome. Key findings include the necessity for multiple hospital visits, the initiation of direct oral anticoagulants (DOACs), and patient delays.
Statistical analysis, including the Kolmogorov-Smirnov test, revealed a significant disparity in D-Dimer distributions between positive and negative instances. Patients with positive Doppler results had a notably higher likelihood of having elevated D-Dimer levels (>2000) (p-value = 0.0005483). However, the high rate of false positives associated with D-Dimer testing indicates that its use as a triage tool is clinically inadequate.
Conclusion: The current DVT referral process is not efficient and often leads to unnecessary diagnostic procedures, negatively impacting patient results and medical resource utilization. The low success rate highlights significant inefficiencies in the referral process, leading to extended patient wait times and unnecessary consumption of healthcare resources. The objective of a revised referral method is to minimize unnecessary scans and optimize patient care by prioritizing clinical evaluation over D-Dimer testing to enhance the accuracy of DVT diagnosis.