Serial ultrasonography

Read our disclaimer for details. Recruitment status was: Recruiting First Posted : March 25, Last Update Posted : December 9, Study Description. Detailed Description:. Arms and Interventions. Ultrasound to measure fetal growth every 4 weeks i. Outcome Measures. Primary Outcome Measures : Frequency of detection of fetal growth abnormalities, starting at 28 weeks gestational age [ Time Frame: up to 72 hours after delivery ].

Secondary Outcome Measures : Birthweight compared to antenatal estimated fetal weights [ Time Frame: At delivery ] Comparison of estimated fetal weight by ultrasound to actual birth weight at delivery. Eligibility Criteria. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Contacts and Locations. Keywords: Diaphragm contraction velocity; Diaphragm excursion; Diaphragm ultrasonography; Extubation outcome; Mechanical ventilation; Weaning.

Abstract Introduction: Diaphragm excursion and contraction velocity measured using ultrasonography have been used to assess diaphragm function. Publication types Observational Study. The latter approach is thought to be better based on its ability to detect isolated calf vein thrombosis; however, it requires skilled operators and is mainly available only during working hours. No randomized comparisons are yet available evaluating the relative values of these 2 strategies.

Objective: To assess if the 2 diagnostic strategies are equivalent for the management of symptomatic outpatients with suspected DVT of the lower extremities. A randomization list was available for each center, arranged by blocks of 10 patients to ensure balancing generated by nQuery functionality [nQuery Advisor; Statistical Solutions Ltd, Cork, Ireland]. Two-Point Strategy. Patients with normal ultrasound findings at presentation underwent D-dimer testing.

Patients with normal D-dimer levels were spared further investigation and were not anticoagulated. Patients with abnormal D-dimer levels were scheduled for a repeat ultrasonography at 1 week, or earlier if clinically indicated.

Those patients with normal repeat ultrasound findings were spared further investigation and were not anticoagulated. Whole-Leg Strategy. Patients with normal ultrasound results at presentation were spared further investigation and were not anticoagulated.

Patients with normal findings at the initial diagnostic workup were scheduled for an end of follow-up visit after 3 months, which consisted of 1 a standardized interview to assess their general health status, chest or leg complaints, and history of hospital admission for any cause; 2 a physical examination; and 3 an ultrasonographic evaluation. Patients were instructed to refer to the study centers immediately if they experienced syncope, shortness of breath, chest pain, palpitations, and either new or worsening leg symptoms.

Patients who did not attend the scheduled visit were contacted by telephone by the investigators and interviewed using a standardized questionnaire to assess their general health status, chest or leg complaints, and history of hospital admission for any cause.

All diagnostic evaluations were performed by certified physicians with long-standing experience in vascular ultrasonography. Two-point ultrasonography was performed and interpreted as described elsewhere. Vein incompressibility was the only diagnostic criterion applied.

Test results were categorized as normal compressible veins or abnormal noncompressible veins. Lacking a widely accepted protocol for whole-leg ultrasonography, the standard procedure for the study purposes was agreed a priori by all investigators during a consensus meeting held before the beginning of the study.

All veins were imaged continuously along their length, in the transverse plane, with a linear probe MHz. The proximal deep veins were examined first, including the femoral veins common, superficial, and deep and the popliteal vein down to its trifurcation. Then, only in patients with normal proximal findings, the calf veins were evaluated, including the axial peroneal and posterior tibial and the muscular veins.

Vein incompressibility was the sole diagnostic criterion adopted for abnormal testing of the proximal and axial calf veins. Adjunctive criteria for abnormal testing of the muscular veins only included lack of spontaneous or reverse-flow intraluminal color-filling after augmentation maneuvers ie, manual squeezing of the calf.

We assessed the incidence of objectively proven symptomatic VTE occurring during a 3-month follow-up period in patients with normal findings at the initial diagnostic workup, with either of the 2 diagnostic strategies. All suspected symptomatic events were to be evaluated as follows. Deep vein thrombosis was confirmed by abnormal findings on compression ultrasonography or venography, and pulmonary embolism was confirmed by abnormal computed tomography, high probability ventilation-perfusion lung scanning, or abnormal pulmonary angiography.

Fatal pulmonary embolism was adjudicated by autopsy, or on clinical grounds in case of sudden and otherwise inexplicable death, according to the opinion of an independent physician. An independent and blind committee adjudicated the suspected thromboembolic events based on all relevant documents and footage.

As specified in the study protocol, the investigation was designed to determine whether the 2 strategies would have similar safety ie, as an equivalence study. Sample size was estimated by nQuery Advisor version 5. Statistical analyses were performed by using SPSS statistical software version Of eligible patients with suspected DVT, were excluded because the patients did not meet inclusion criteria and 22 refused to participate Figure.

Table 1 shows the demographic and clinical characteristics of the study patients at entry. Of patients randomized to the 2-point strategy, A total of patients D-dimer testing results were abnormal in of patients During the week, none of these patients received antithrombotic drugs and none developed signs or symptoms of pulmonary embolism; however, 17 patients presented for retesting during the week because of worsening leg symptoms of these, 2 patients had abnormal ultrasound test results.

Of the patients with improved or unchanged leg symptoms who presented for repeat ultrasonography at the 1-week visit, 12 had abnormal findings.

Thus, 14 of the patients 5. The remaining patients, which included patients with normal D-dimer and patients with abnormal D-dimer and normal serial ultrasonography, were not anticoagulated and were followed up for 3 months.

Of the patients randomized to the whole-leg strategy, Of these, patients The remaining patients with normal ultrasound findings were not anticoagulated and were followed up for 3 months. Table 2 shows the type, timing, diagnostic method used, and location of the outcome events that occurred during the 3 months of follow-up.

Of patients allocated to the 2-point strategy, 9 1. Sixteen patients had suspected symptomatic VTE during the follow-up period, which was objectively confirmed in 7 patients and not found in 9 patients.

Therefore, in this group, the incidence of confirmed symptomatic VTE during the 3-month follow-up period was 0. Of patients randomized to the whole-leg strategy, 7 0.

Twenty-one patients had suspected symptomatic VTE during the follow-up period, which was objectively confirmed in 9 patients and not found in 12 patients.