Transcription of EVIDENCE-BASED CLINICAL MEDICINE Approach …
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EVIDENCE-BASED CLINICAL MEDICINE Approach …
EVIDENCE-BASED CLINICAL MEDICINEA pproach to Leg Edema of Unclear EtiologyJohn W. Ely, MD, MSPH, Jerome A. Osheroff, MD, M. Lee Chambliss, MD, MSPH, andMark H. Ebell, MD, MSA common challenge for primary care physicians is to determine the cause and find an effective treat-ment for leg edema of unclear etiology. We were unable to find existing practice guidelines that addressthis problem in a comprehensive manner. This article provides clinically oriented recommendations forthe management of leg edema in adults. We searched on-line resources, textbooks, and MEDLINE (usingthe MeSH term, edema ) to find clinically relevant articles on leg edema. We then expanded the searchby reviewing articles cited in the initial sources. Our goal was to write a brief, focused review thatwould answer questions about the management of leg edema. We organized the information to make itrapidly accessible to busy clinicians. The most common cause of leg edema in older adults is venousinsufficiency.
In patients with acute edema ( 72 hours), a nor-mal D-dimer will essentially rule out deep vein thrombosis if the clinical suspicion is low because
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