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Plethysmography of lower extremity
1%
22/3404
MRI of lower extremity
0%
12/3404
CT angiography of lower extremity
43/3404
Venous ultrasonography
94%
3190/3404
Knee aspiration to evaluate for septic joint
4%
129/3404
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Venous ultrasonography is the next best step in this patient's management, due to the clinical picture of a deep venous thrombosis. The most sensitive and specific recommended diagnostic procedure is a venous ultrasonography. In their multi-center study, Haut et al. hypothesized that admission to trauma centers that use duplex ultrasound more frequently would independently predict increased DVT reporting for individual patients. They indeed found that trauma centers ultrasound practice was an independent predictor of DVT diagnosis for individual patients, controlling for patient-level risk factors, but concluded the elevated DVT rates at these centers were due to surveillance bias. As such, they recommend that surveillance for DVT should not be considered as a quality control measure in the care of trauma patients.
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