Homan’s Sign and DVTs

1. Homan’s Sign and DVTs Clinical Question In surgical patients, is Homan’s sign a reliable nursing tool for detecting the presence of deep vein thrombosis? • Synthesis of findings • - Physical assessment findings such as Homan’s sign alone are poor predictors of the presence or severity of thrombosis • EBP does not discourage the use of Homan’s sign • New physical assessment tools such as the Well’s score do not include the use of Homan’s sign • Homan’s sign is nonspecific, unreliable, and not considered a diagnostic sign for DVTs • It remains as an assessment tool for DVTs • A positive Homan’s sign does not necessarily correlate with the presence of a DVT Decision about practice EBP not only takes quality of research into account but also: cost, clinical expertise, and patient preference. Testing for Homan’s sign is inexpensive, can be useful when combined with a thorough risk assessment and is well tolerated by patients. Discussion Based on our findings, Homan’s sign is a time honored assessment that is not necessarily reliable. There should be less emphasis on Homan’s sign as a sole diagnostic tool for the physical assessment of a DVT. It is best used in combination with patient history, risk factors, clinical manifestations, and other diagnostic tools. • Literature Review • Highest Level: • ٥ Meta Analysis: 2005 Annals of Internal Medicine • ٥ EBP: National Guidelines Clearinghouse: 4 Guidelines • 2. Medium Level: • ٥ Prospective Cohort Study: 2011 Taipei Veterans • ٥ Case control: Problems of acute deep venous thrombosis (1969) • Low Level: • ٥ Expert opinion • Sample Characteristics: Patients undergoing surgery, medical pateints (ie: stroke, cancer), women who are pregnant, delivering, or post-partum, women taking oral contraceptives or hormone replacement therapy • Settings: Mostly US hospitals, Adult surgical units Implementation Emphasize in clinical training and nursing programs that Homan’s sign should not be used solely as a diagnostic tool and is widely viewed as unreliable. It must always be used in conjunction with a thorough assessment and followed up with further diagnostic testing. References ACR Appropriateness Criteria® suspected lower extremity deep vein thrombosis. 1995 (revised 2010). NGC:007937. American College of Radiology - Medical Specialty Society. Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. 2007 Jan/Feb. NGC:005523. American Academy of Family Physicians - Medical Specialty Society; American College of Physicians - Medical Specialty Society. Goodacre, S., & Sutton, A., & Sampson F. (2005) Meta-Analysis: The Value of Clinical Assessment in the Diagnosis of Deep Venous Thrombosis. American College of Physicians.Annals of Internal Medicine, Volume 143, Number 2. Hawker, K. (1969). Problems of acute deep venous thrombosis. I. The interpretation of signs and symptoms. Angiology, 20(4), 219-223. Retrieved from EBSCOhost. Prevention and management of venous thromboembolism. A national clinical guideline. 2002 Oct (revised 2010 Dec). NGC:008257. Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.] Thrombosis; New Research on Thrombosis from Taipei Veterans General Hospitalized Summarized. Obesity, Fitness & Wellness Week. Atlanta: Feb 2011. Urbano, Frank L. (2001) Homans’ sign in the diagnosis of deep venous thrombosis. Hospital Physician. March 2001; pp 22-24. Turner White Communications Inc., Wayne, PA Venous thromboembolism diagnosis and treatment. 1998 Jun (revised 2010 Feb). [NGC Update Pending] NGC:007844. Institute for Clinical Systems Improvement - Nonprofit Organization. Method Databases: National Guideline Clearinghouse, PubMed, Ovid, Joanna Briggs Institute – Nursing Database, Cochrane Library Search Strategy: Use advanced search option to display “document text” to search the entire document for Homan’s sign Keywords/MeSH terms: Homan’s sign, Deep Vein Thrombosis, venous thromboembolism, pulmonary embolism, prevention, diagnosis, thrombophlebitis/diagnosis Evaluation Nurses and nursing students will assess for alternative and more reliable clinical manifestations of DVTs such as unilateral calf swelling of more than 3 cms. This will lead to increased and/or earlier detection of DVTs.