Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202002171
Jornal Vascular Brasileiro
Original Article

Avaliação do manejo diagnóstico de trombose venosa profunda no departamento de emergência de um hospital terciário em Santa Catarina: um estudo transversal

Evaluation of the diagnostic management of deep vein thrombosis in the emergency department of a tertiary hospital in Santa Catarina, Brazil: a cross-sectional study

Lucas Tramujas; Márcio Mesquita Judice; Angela Bueno Becker

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Resumo

Resumo: Contexto: O tromboembolismo venoso é uma entidade que compreende a trombose venosa profunda e o tromboembolismo pulmonar. Embora os protocolos para diagnóstico dessas doenças estejam bem definidos, evidências têm demonstrado uso inadequado de recursos diagnósticos.

Objetivos: Definir o perfil epidemiológico dos pacientes com suspeita de trombose venosa profunda admitidos na emergência, determinar taxas de inadequação nas solicitações de D-dímero e eco-Doppler colorido venoso de membros inferiores e identificar se essas solicitações seguiram as recomendações da diretriz da Sociedade Brasileira de Angiologia e Cirurgia Vascular de 2015.

Métodos: Estudo observacional transversal que avaliou retrospectivamente 168 pacientes com suspeita de trombose venosa profunda, aos quais foi solicitado D-dímero. Foram mensurados os fatores de risco mais comuns e a probabilidade pré-teste pelo escore de Wells. O perfil epidemiológico desses pacientes, assim como as taxas de inadequação, foram avaliados por meio de uso de estatística descritiva.

Resultados: Em 55 (32,7%) casos, as solicitações de D-dímero foram inadequadas. Em 14 (8,3%) pacientes com baixa probabilidade no escore de Wells e D-dímero negativo, houve uso desnecessário de eco-Doppler colorido venoso de membros inferiores, sendo que, em 19 (11,3%) daqueles com baixa probabilidade no escore de Wells e D-dímero elevado, não houve complementação diagnóstica. O uso de eco-Doppler colorido venoso foi inadequado em 35 (20,8%) casos. A taxa global de inadequação foi de 53,5%.

Conclusões: Constataram-se divergências entre a prática clínica e as recomendações propostas para avaliação diagnóstica nos pacientes com suspeita de trombose venosa profunda devido ao uso inadequado de testes diagnósticos.

Palavras-chave

trombose venosa, diagnóstico, protocolos clínicos

Abstract

Background: Venous thromboembolism is an entity that encompasses both deep vein thrombosis and pulmonary thromboembolism. Although protocols for the diagnosis of these diseases are well defined, there is evidence of inappropriate use of diagnostic resources. Objectives: To define the epidemiological profiles of patients admitted to the emergency department with suspected deep vein thrombosis, to determine rates of inappropriate ordering of D-dimer assays and color venous Doppler echocardiography of the lower limbs, and to identify whether these requests followed the recommendations contained in the 2015 Brazilian Society of Angiology and Vascular Surgery guidelines. Methods: We conducted a cross-sectional observational study that retrospectively evaluated 168 patients with suspected deep vein thrombosis for whom D-dimer assays were requested. The most common risk factors were measured and the pretest probability was calculated with the Wells score. The epidemiological profile of these patients and the rates of inappropriate D-dimer testing were assessed using descriptive statistics. Results: The D-dimer requests were inadequate in 55 (32.7%) patients. Venous color Doppler ultrasound was used to examine the lower limbs of 14 (8.3%) of the patients with a low probability according to the Wells score and a negative D-dimer result. No additional diagnostic methods were used in 19 (11.3%) of those with a low probability according to the Wells score and a high D-dimer result. There was unnecessary use of CDUS in 35 (20.8%) cases. The overall rate of inappropriate workup was 53.5%. Conclusions: Differences were found between clinical practice and the recommendations for diagnostic evaluation of patients with suspected deep vein thrombosis, with inappropriate use of diagnostic tests.

Keywords

venous thrombosis; diagnosis; clinical protocols.

References

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Submitted date:
05/02/2021

Accepted date:
07/20/2022

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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