Clinical Consult

I am looking for references on the sensitivity of the Homan’s Sign/Test for ruling out DVT in a patient s/p arthroscopic knee surgery.  I have found several references concerning reliability, specificity, risk factors, clinical signs and symptoms, etc (and even an article that suggested it was not sensitive, but didn’t elaborate or reference this statement).  I have yet to encounter any reference that reports sensitivity numbers.  I would also appreciate any thoughts on what would be considered “entry-level” knowledge in terms of screening for DVT.  Is it enough to recognize risk factors and clinical signs and symptoms (such as the Homan’s sign), or would entry-level clinicians be expected to know algorithms such as the Wells criteria (as studied in the PT population by Riddle, et al, Physical Therapy, August 2004)?

Thanks,

Mike

 

Comments

[Adam Rufa]

I think that students should definitely be taught the Wells criterion. It is simple and has the most support in the literature.

[Morey Kolber]

I teach the Wells criteria to the students in their ortho 1 class

[Bob DuVall]

Given that Wells' DVT algorithm has been published by Riddle in our literature (PT Vol 84, #8 August 2004), I ask would this not be the standard to which all PTs are held accountable, especially in legal scenarios like a malpractice case, i.e. would it not be negligent if a PT missed a DVT and didn't have documented evidence of employing Well's algorithm? I applaud Riddle for publishing Well's important algorithm in our literature. I trust that curricula is sensitive to this type evidence and is dynamic to quickly translate these criteria and clinical prediction rules into academic preparation and practice. Likewise, I trust that the grassroots experienced practitioner also has methods to rapidly translate recently published evidence into clinical practice. I feel that one of the benefits of serving as a clinical education site for academic programs provides a conduit for this purpose. Likewise, clinical residency and fellowship programs also serve as an excellent means to incorporate recently published EBP as well as create new evidence.
Bob DuVall
Director, Orthopaedic Primary Care Residency and Manual Therapy Fellowship Program
SportsMedicine of Atlanta

[Brian]

We had a post about this on our blog recently. Here is the link:
http://orthosportsrehab.blogspot.com/2006/10/clinical-prediction-rule-for-dvt-in.html

From what was discussed at our journal club on the topic, there is not much evidence for the Homan's Sign. The Well's criteria seems to be what is taught in PT school currently, but the Risk Assessment Score may be worth looking at.

[Robin Smith]

The article about medical negligence in singapore is really informative..Thanks a lot really for posting it.

http://abcd121.createblog.com/blog/entry.php?id=28606

[Gianna]

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http://www.rapidsharemix.com