Virtual clinical risk assessment template for deep venous thrombosis
| Parameters | Evaluation | Instructions/findings/documentation |
|---|---|---|
| Undertaking virtual patient history | ||
| History | General | Note area of tenderness Length of time of symptoms. Rule out trauma. Exclude bilateral leg swelling. |
| Well-being | ||
| COVID-19 symptoms | ||
| - Fever | ||
| - Continuous cough | ||
| - Change or loss of smell and/or taste | ||
| DVT | ||
| Calf pain—throbbing, erythema, swelling, tenderness, cramps | ||
| PE | ||
| -Pleuritic chest pain | ||
| -Sudden shortness of breath | ||
| -Dizziness or fainting | ||
| -Haemoptysis | ||
| -Palpitations | ||
| -Peripheral cyanosis | ||
| Risk factors | Prolonged immobility, surgery, plaster cast, long haul flight, HRT, pregnancy, smoking, cancer, previous thrombosis, coagulation disorders, for example, APS | |
| Medications | Hormone treatment, OC pills, chemotherapy | |
| Recent surgery | Hip and knee arthroplasty, hip fracture | |
| Medical history | Enquire relevant medical history and in-hospital admissions | |
| Virtual examination of limb | ||
| Parameters | Evaluation to document | Verbal clues and instructions for the patient |
| Look | General 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 None/mild/moderate/severe/ 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? | |
| Feel | Calf 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. | |
| Move | Painful 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. |
| Measurement | Calf 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.