Center representatives performed a search of MEDLINE and the Cochrane libraries for systematic reviews, meta-analyses, prospective clinical trials and diagnostic studies evaluating the use of color duplex ultrasound in Western adult inpatients with no signs or symptoms of deep venous thrombosis (DVT). The MEDLINE database was searched using the terms "venous thrombosis [MeSH]" AND ("asymptomatic[kw]" OR "surveillance[kw]" OR ("screening[kw]" OR "mass screening[MeSH]") limited to humans and English language and "all adult (19 plus years)" and (clinical trial or controlled clinical trial or meta analysis or randomized controlled trial).
The Cochrane libraries (The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and The Cochrane Central Register of Controlled Trials) were searched using the terms "ultrasound" in Title, Abstract or Keywords AND "venous thrombosis" in Title, Abstract or Keywords.
In total, 62 studies were initially identified from the MEDLINE and Cochrane databases of which 6 studies were ultimately used for the review.
Local guidelines were also reviewed (see Appendices 1 and 2 in the original guideline document), and a systematic review of national guidelines was performed using the National Guideline Clearinghouse and following criteria:
Keyword: deep venous thrombosis Methods Used to Assess the Quality and Strength of the Evidence: Weighting According to a Rating Scheme (Scheme Given), Weighting According to a Rating Scheme (Scheme Not Given) Methods Used to Analyze the Evidence: Meta-Analysis, Meta-Analysis of Individual Patient Data, Meta-Analysis of Randomized Controlled Trials, Meta-Analysis of Summarized Patient Data, Review, Review of Published Meta-Analyses, Systematic Review, Systematic Review with Evidence Tables Age Range: Adult (19 to 44 years), Aged (65 to 79 years), Aged (80 and over), Middle Age (45 to 64 years) Publication Date(s): 2006, 2005, 2004, 2003, 2002, 2001
The search was limited to guidelines developed in the United States. In total, three guidelines were found. In addition, Task Force participants recommended the use of two other guidelines (Eastern Association for the Surgery of Trauma [Trauma EAST] Group and Physicians' Information and Education Resource [PIER]).
The guidelines were used in a number of ways. First, the reference lists of the five guidelines were searched using the criteria established for the MEDLINE and Cochrane searches above, but no additional studies meeting the inclusion criteria were found. Next, the task force abstracted guideline recommendations that addressed the question of interest (see Appendix 4 in the original guideline document). In addition, the task force searched the reference lists of the two leading guidelines (the Seventh American College of Chest Physicians [ACCP] Guideline and the Trauma East Guideline) for references addressing the risk of incident DVT and pulmonary embolism (PE) in populations receiving anticoagulation. Risk groups, risk of venous thromboembolism (VTE), method of ascertainment, follow up period, and number of studies were abstracted from the relevant references into an evidence table (Table 7 in the original guideline document). In a separate table, the task force further abstracted the risk of all VTE, all DVT, Proximal DVT, Distal DVT, and PE from all randomized clinical trials (RCTs) using low molecular weight heparin (LMWH) in >1 arm from risk groups that demonstrated a risk of VTE of >20% as ascertained by venography (Table 8 in the original guideline document). In total, data from 28 orthopedic studies, 2 neurosurgery studies, 2 major trauma studies, and 1 spinal cord injury study were abstracted.