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Multicenter assessment of venous reflux by duplex ultrasound

Lurie, Fedor; Comerota, Anthony; Eklof, Bo G. LU ; Kistner, Robert L.; Labropoulos, Nicos; Lohr, Joann; Marston, William; Meissner, Mark; Moneta, Gregory and Neglen, Peter, et al. (2012) In Journal of Vascular Surgery 55(2). p.437-445
Abstract
Objective: This prospective multicenter investigation was conducted to define the repeatability of duplex-based identification of venous reflux and the relative effect of key parameters on the reproducibility of the test. Methods: Repeatability was studied by having the same technologist perform duplicate tests, at the same time of the day, using the same reflux-provoking maneuver and with the patient in the same position. Reproducibility was examined by having two different technologists perform the test at the same time of the day, using the same reflux-provoking maneuver and with the patient in the same position. Facilitated reproducibility was studied by having two different technologists examine the same patients immediately after an... (More)
Objective: This prospective multicenter investigation was conducted to define the repeatability of duplex-based identification of venous reflux and the relative effect of key parameters on the reproducibility of the test. Methods: Repeatability was studied by having the same technologist perform duplicate tests, at the same time of the day, using the same reflux-provoking maneuver and with the patient in the same position. Reproducibility was examined by having two different technologists perform the test at the same time of the day, using the same reflux-provoking maneuver and with the patient in the same position. Facilitated reproducibility was studied by having two different technologists examine the same patients immediately after an educational intervention. Limits of agreement between two duplex scans were studied by changing three elements of the test: time of the day (morning vs afternoon), patient's position (standing vs supine), and reflux initiation (manual vs automatic compression decompression). Results: The study enrolled 17 healthy volunteers and 57 patients with primary chronic venous disease. Repeatability of reflux time measurements in deep veins did not significantly differ with the time of day, the patient's position, or the reflux-provoking maneuver. Reflux measurements in the superficial veins were more repeatable (P < .05) when performed in the morning with the patient standing. The agreement between the clinical interpretations significantly depended on a selected cut point (Spearman's rho, -0.4; P < .01). Interpretations agreed in 93.4% of the replicated measurements when a 0.5-second cut point was selected. The training intervention improved the frequency of agreement to 94.4% (kappa = 0.9). Alternations of the time of the duplex scan, the patient's position, and the reflux-provoking maneuver significantly decreased reliability. Conclusions: This study provides evidence to develop a new standard for duplex ultrasound detection of venous reflux. Reports should include information on the time of the test, the patient's position, and the provoking maneuver used. Adopting a uniform cut point of 0.5 second for pathologic reflux can significantly improve the reliability of reflux detection. Implementation of a standard protocol should elevate the minimal standard for agreement between repeated tests from the current 70% to at least 80% and with more rigid standardization, to 90%. (J Vase Surg 2012;55:437-45.) (Less)
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Journal of Vascular Surgery
volume
55
issue
2
pages
437 - 445
publisher
Mosby
external identifiers
  • wos:000299446600017
  • scopus:84856117131
ISSN
1097-6809
DOI
10.1016/j.jvs.2011.06.121
language
English
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yes
id
e40cdb4f-05a3-4d2c-a2d8-461142e67a3c (old id 2416195)
date added to LUP
2012-04-02 09:39:45
date last changed
2017-08-06 03:59:30
@article{e40cdb4f-05a3-4d2c-a2d8-461142e67a3c,
  abstract     = {Objective: This prospective multicenter investigation was conducted to define the repeatability of duplex-based identification of venous reflux and the relative effect of key parameters on the reproducibility of the test. Methods: Repeatability was studied by having the same technologist perform duplicate tests, at the same time of the day, using the same reflux-provoking maneuver and with the patient in the same position. Reproducibility was examined by having two different technologists perform the test at the same time of the day, using the same reflux-provoking maneuver and with the patient in the same position. Facilitated reproducibility was studied by having two different technologists examine the same patients immediately after an educational intervention. Limits of agreement between two duplex scans were studied by changing three elements of the test: time of the day (morning vs afternoon), patient's position (standing vs supine), and reflux initiation (manual vs automatic compression decompression). Results: The study enrolled 17 healthy volunteers and 57 patients with primary chronic venous disease. Repeatability of reflux time measurements in deep veins did not significantly differ with the time of day, the patient's position, or the reflux-provoking maneuver. Reflux measurements in the superficial veins were more repeatable (P &lt; .05) when performed in the morning with the patient standing. The agreement between the clinical interpretations significantly depended on a selected cut point (Spearman's rho, -0.4; P &lt; .01). Interpretations agreed in 93.4% of the replicated measurements when a 0.5-second cut point was selected. The training intervention improved the frequency of agreement to 94.4% (kappa = 0.9). Alternations of the time of the duplex scan, the patient's position, and the reflux-provoking maneuver significantly decreased reliability. Conclusions: This study provides evidence to develop a new standard for duplex ultrasound detection of venous reflux. Reports should include information on the time of the test, the patient's position, and the provoking maneuver used. Adopting a uniform cut point of 0.5 second for pathologic reflux can significantly improve the reliability of reflux detection. Implementation of a standard protocol should elevate the minimal standard for agreement between repeated tests from the current 70% to at least 80% and with more rigid standardization, to 90%. (J Vase Surg 2012;55:437-45.)},
  author       = {Lurie, Fedor and Comerota, Anthony and Eklof, Bo G. and Kistner, Robert L. and Labropoulos, Nicos and Lohr, Joann and Marston, William and Meissner, Mark and Moneta, Gregory and Neglen, Peter and Neuhardt, Diana and Padberg, Frank, Jr. and Welsh, Harold J.},
  issn         = {1097-6809},
  language     = {eng},
  number       = {2},
  pages        = {437--445},
  publisher    = {Mosby},
  series       = {Journal of Vascular Surgery},
  title        = {Multicenter assessment of venous reflux by duplex ultrasound},
  url          = {http://dx.doi.org/10.1016/j.jvs.2011.06.121},
  volume       = {55},
  year         = {2012},
}