Table 1

Virtual clinical risk assessment template for deep venous thrombosis

Undertaking virtual patient history
HistoryGeneralNote area of tenderness
Length of time of symptoms. Rule out trauma. Exclude bilateral leg swelling.
COVID-19 symptoms
- Fever
- Continuous cough
- Change or loss of smell and/or taste
Calf pain—throbbing, erythema, swelling, tenderness, cramps
-Pleuritic chest pain
-Sudden shortness of breath
-Dizziness or fainting
-Peripheral cyanosis
Risk factorsProlonged immobility, surgery, plaster cast, long haul flight, HRT, pregnancy, smoking, cancer, previous thrombosis, coagulation disorders, for example, APS
MedicationsHormone treatment, OC pills, chemotherapy
Recent surgeryHip and knee arthroplasty, hip fracture
Medical historyEnquire relevant medical history and in-hospital admissions
Virtual examination of limb
Parameters Evaluation to document Verbal clues and instructions for the patient
LookGeneral advice for the virtual examination It is acceptable if the patient needs help from a relative or friend for reassurance and help during virtual examination.
Extremity being examined should face the camera.
Patient sat in a chair. Feet flat on the floor and knees bent.
Please wear shorts or skirt. Patient to remove shoes and socks.
Please expose both legs up-to mid-thigh.
Swollen, oedema of the leg
If obvious oedema/swelling of the leg
Leg being examined should face the camera please.
With camera facing you, please place your thumb against the shin and press the front of the leg just above the ankle for 30 s.
Erythema, any signs of inflammation, redness or bluish discolouration
Any obvious collateral (non-varicose) superficial veins dilatation or superficial thrombophlebitis.
Leg being examined should face the camera please.
Do you feel the leg hot?
Any scars, for example, from an operation Do you have any scars for us to see?
FeelCalf pain
Ensure deep veins examined.
Is the leg or calf painful? Please point with your finger the site of pain.
Please try to press your calf—Does this cause pain?
Leg temperature Please use the back of your hand to check for temperature and compare it with the opposite leg.
MovePainful dorsiflexion and plantar flexion of ankle
Pain on weight-bearing, observe gait
Does stretching your ankle up and down cause pain?
Please walk few steps away from the camera. Turn around and walk back towards the camera.
MeasurementCalf circumference
If >3 cm difference from other leg-> significant
Ask patient to measure calf swelling by measuring tape, measuring 10 cm below the bony prominence below and front of the knee. A representative picture can be shown on synchronous transmission.
Please measure the girth of your both legs at same levels.
  • APS, anti-phospholipid syndrome; DVT, deep venous thrombosis; HRT, hormone replacement therapy; OC, oral contraceptives; PE, pulmonary embolism.