Deep Venous Thrombosis (DVT) in Trauma: a Literature Review

Impedance Plethysmography (IPG)

First Author	Year	Reference Title	Class	Conclusions
Wheeler HB	1970	Detection of venous obstruction in the leg by measurement of electrical impedance. Ann NY Acad Sci 170:804-11	III	First description on the use of IPG to detect DVT.
Wheeler HB	1994	Diagnostic tests for deep vein thrombosis. Clinical usefulness depends on probability of disease. Arch Intern Med 154:1921-8	I	Excellent review of various diagnostic methods to detect DVT. IPG on meta-analysis had 94% specificity and 90% sensitivity in symptomatic patients but only 29% sensitivity and 97% specificity in asymptomatic patients.
Ginsberg JS	1994	Reevaluation of the sensitivity of impedance plethysmography for the detection of proximal deep vein thrombosis. Arch Intern Med 154:1930-3	II	132 patients had both IPG followed by venogram for clinically suspected DVT. Sensitivity was 65% and specificity was 93% for proximal DVT.
Hull RD	1985	Diagnostic efficacy of impedance plethysmography for clinically suspected deep-vein thrombosis. A randomized trial. Ann Intern Med 102:21-8	III	Large prospective clinical series demonstrated IPG alone is an effective strategy in the detection of DVT.
Huisman MV	1986	Serial impedance plethysmography for suspected deep venous thrombosis in outpatients. N Engl J Med 314:823-8	III	Large prospective study showing serial IPG was successful in diagnosing DVT in 92% of patients with clinically suspected DVT.

Impedance Plethysmography (IPG)

First Author	Year	Reference Title	Class	Conclusions
Huisman MV	1989	Management of clinically suspected acute venous thrombosis in outpatients with serial impedance plethysmography in a community hospital setting. Arch intern Med 149:511-3	II	Serial IPG for clinically suspected DVT in outpatients. The positive predictive value of abnormal IPG for venography - proven DVT was 90%.
Cruickshank MK	1989	An evaluation of impedance plethysmography and 125I-fibrinogen leg scanning in patients following hip surgery. Thromb Haemost 62:830-4	II	IPG in 685 hip surgery patients revealed a sensitivity of 12.9% and specificity of 98.1% compared to venography.
Hull RD	1996	Cost-effectiveness of pulmonary embolism diagnosis. Arch Intern Med 156:68-72	II	Most cost-effective method to diagnose PE that requires pulmonary angiography in the fewest number of patients is VQ lung scan and serial IPG.
Geerts WH	1994	A prospective study of venous thromboembolism after major trauma. N Engl J Med 331:1601-6	II	Large study on the incidence of DVT in nonprophylaxed trauma patients. Used some IPG for diagnosis of DVT.
Rogers FB	1993	Prophylactic vena cava filter insertion in severely injured trauma patients: Indications and preliminary results. J Trauma 35:637-42	III	A study of prophylactic vena cava filters in high risk trauma patients. Serial IPG revealed 17.6% DVT rate in this group of patients. No comparison of IPG to venogram in this study.
Shackford SR	1990	Venous thromboembolism in patients with major trauma. Am J Surg 159:365-9	III	High risk trauma patients on prophylaxis screened with serial IPG - a 7% DVT rate was found in patients with at least one risk factor.
Becker DM	1987	Prevention of deep venous thrombosis in patients with acute spinal cord injuries: Use of rotating treatment tables. Neurosurgery 20:675-7	III	Small series of spinal cord injured patients compared 125I-fibrinogen to IPG.