病人若被发现单侧下肢水肿.pptVIP

EBM Supervisor : VS 葉子洪 醫師 Presented by R1 洪芝宜 Identifying Information Name: 李x伯 Sex: male Age: 76 y/o Chart Number:Date of Admission: 2010/10/25 Diagnosis: COPD+AE Chronic diarrhea Ascites, r/o malnutrition 99.11.17 Right lower extremity edema was noted Suspected DVT compression ultrasound was arranged 問題 病人若被發現單側下肢水腫，懷疑有下肢DVT，安排compression ultrasound (CUS)結果常顯示為正常，但是compression ultrasound (CUS)無法偵測到Distal (calf) vein thrombosis, 常要重復檢查 是否有更方便又有效的檢查方式? Review Introduction venous thromboembolism (VTE) Deep vein thrombosis (DVT) Acute pulmonary embolism (PE) DVT of the lower extremity Distal (calf) vein thrombosis Proximal vein thrombosis Introduction Classic symptoms swelling, pain, and discoloration in the involved extremity Physical examination palpable cord (reflecting a thrombosed vein) ipsilateral edema, warmth, and/or superficial venous dilation Introduction However, the clinical diagnosis of DVT is not?sufficiently accurate since the symptoms and findings are often nonspecific. Thus, testing is generally indicated to confirm or exclude the diagnosis. 回歸到我們的問題 臨床上，當懷疑病人有下肢的DVT時，而compression ultrasound (CUS) 結果顯示為正常，應於5-7天後在另排一次compression ultrasound (CUS) ，但基於某些原因，不見得會再排 想探討是否一開始即使用complete lower extremity ultrsound 取代傳統的compression ultrasound (CUS) ? PICO P: In patients with suspected lower extremity deep vein thrombosis (DVT) I: complete lower extremity ultrsound C: compression ultrasound (CUS) O: determine the risk of venous thromboembolism Database Search keywords DVT compression ultrasound Critical Appraisal of Systematic Review“系統性回顧”的評析 Are the results of the review valid (效度如何)? What question did the systematic review addressed (回答什麼問題)? Is it unlikely that important, relevant studies were missed (沒有遺漏重要的文獻)? Were the criteria used to select articles for inclusion appropriate (選擇文獻的準則適當)? Were the included studies sufficiently valid for the type of question asked (選擇的文獻有效