What’s Your Diagnosis? Deep Vein Thrombosis: Emergency Department Management Recommendations
September 22, 2020
Posted by Andy Jagoda MD in: What's Your Diagnosis , trackback
Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got last month’s case on Infective Endocarditis in the ED: Recognition, Diagnosis, and Treatment right.
Case Presentation: Management of Deep Vein Thrombosis in the Emergency Department
A 20-year-old woman presents with a 3-day history of left lower extremity pain and swelling. On examination, her left lower leg is visibly larger than the right. She is concerned that she has a blood clot, because her mother had one several years ago. She says that she does not have health insurance and will be self-paying for her visit. She asks you to keep the cost of the visit as low as possible. You wonder whether there is clinical decision rule that could be used to aid in choosing a cost-effective diagnostic strategy…
For the 20-year-old woman with leg pain concerning for DVT, you decided to risk stratify her using the Wells score. Based on a further history and physical examination, you determined that she was at low probability for having a DVT. You obtained a high-sensitivity D-dimer, which was negative, and she was discharged home.