Quality statement 2: Diagnosis of deep vein thrombosis

Quality statement

People with suspected deep vein thrombosis have all diagnostic investigations completed within 24 hours of first clinical suspicion.

Rationale

It is important that all diagnostic investigations for suspected deep vein thrombosis (DVT) are completed within 24 hours to ensure prompt treatment if the diagnosis is confirmed, and to avoid unnecessary repeat doses of anticoagulants if the diagnosis is excluded.

Quality measures

Structure

Evidence of local arrangements to ensure people with suspected DVT have all diagnostic investigations completed within 24 hours of first clinical suspicion.

Data source: Local data collection.

Process

The proportion of people who have all diagnostic investigations completed within 24 hours of first clinical suspicion.

Numerator – the number of people in the denominator who have all diagnostic investigations completed within 24 hours of first clinical suspicion.

Denominator – the number of people with suspected DVT.

Data source: Local data collection.

Outcome

Incidence of pulmonary embolism (PE) in people who have undergone all diagnostic tests for DVT.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure systems are in place for people with suspected DVT to have all diagnostic investigations completed within 24 hours of first clinical suspicion.

Healthcare professionals ensure people with suspected DVT have all diagnostic investigations completed within 24 hours of first clinical suspicion.

Commissioners ensure they commission services for people with suspected DVT to have all diagnostic investigations completed within 24 hours of first clinical suspicion.

People who may have deep vein thrombosis have all their diagnostic tests done within 24 hours of the tests being requested by an appropriate healthcare professional.

Source guidance

Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. NICE guideline NG158 (2020), recommendations 1.1.1 to 1.1.4, 1.1.8, 1.1.10 and 1.1.22

Definitions

Suspected DVT

The clinical features of suspected DVT and how to estimate the clinical probability of DVT using the 2-level DVT Wells score (calculated from a series of questions about symptoms and medical history) are described in NICE's guideline on venous thromboembolic diseases, table 1 and visual summary. [NICE's guideline on venous thromboembolic diseases, recommendations 1.1.1 and 1.1.2, table 1 and the visual summary for venous thromboembolism: diagnosis and anticoagulation treatment]

Diagnostic investigations

Diagnostic investigations include proximal leg vein ultrasound scans and quantitative D-dimer tests. These investigations and their timing are outlined in NICE's guideline on venous thromboembolic diseases, visual summary. [NICE's guideline on venous thromboembolic diseases, recommendations 1.1.3 and 1.1.4, and the visual summary for venous thromboembolism: diagnosis and anticoagulation treatment]

First clinical suspicion

Clinical suspicion of DVT by an appropriate healthcare professional in community or hospital settings. [Expert opinion]