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Analysis Examines Ultrasound Use for Blood Clots
Date:2/2/2010

ent, pulled the overall results of the meta-analysis too far in one direction, he said.

Another study of 513 hospitalized people who had ultrasound exams for DVT found an incidence of 1.95 percent, the editorial noted. That four-times-higher incidence shows that the same criteria cannot be applied to both hospitalized and ambulatory patients, Livingston said.

The journal editors did a lot of talking before deciding that the paper should be run, he said. "We did a lot of analysis, looked at a lot of the literature," Livingston said. "Based on what I read, if you are ambulatory and have a low probability, with some leg pain, maybe a single ultrasound is good enough. The probability of having a DVT is low, and the test backs up your clinical suspicion. But a post-surgical or cancer patient who has a swollen leg, you would probably treat and look again, because the level of suspicion is high."

Treatment involves clot-preventing drugs, which carry their own danger of excess bleeding. The risk of such bleeding might be worth taking for someone in a hospital bed but not for an otherwise healthy person, Livingston said.

Beyond that, the lesson of the paper can be applied to all meta-analyses that lump together the results of different trials, he said. "It is a good platform to advise caution in judging all meta-analyses," Livingston said.

Averages derived by lumping many studies together can be deceptive, added editorial co-author Dr. Robert A. McNutt, a professor of medicine and chief of the section of patient safety research at Rush University Medical Center in Chicago.

"I prefer as a clinician to see the range of values across the studies rather than the average value of all the studies," McNutt said. "As a clinician, I look at the variability of patients, not the average value across the meta-analysis."

Controlled studies provide valuable evidence for medical practice, "but evidence-based medicine is
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