Homan's Sign?

[TransportJockey]

I have been precepting a new medic on his FTO rides and discovered he didn't know what homans sign is. I asked around and it appears it is not taught anymore. Have y'all been taught it? I'm curious more than anything. I know the sensitivity and specificity are not too high (50% or so) but I was always told it was a helpful tool and some recent classes have brought it back up to me

 

[Pkreilley]

"It has fallen out of favor because a positive sign does not indicate DVT (Likelihood ratio positive = 1) and a negative sign does not rule it out (Likelihood ratio negative = 1)[1] [2] It is estimated to have a sensitivity of 60-88% and a specificity of 30-72%.[3]"
Per Wikipedia

 

[Akulahawk]

I was taught Homan's Sign in medic school a dozen years ago and in my sports med program 8 years prior to that... and as recently as a couple years ago when I started nursing school. Guess what? Nursing school brought up those same issues... I don't check for Homan's Sign. Too many false results positive and negative.

 

[JPINFV]

I was taught it in medical school. In real life we just order a LE ultrasound. Kinda of like things like egophony vs the chest x-ray.

 

[NBFFD2433]

I took my NREMT about a year and a half a go and I was tought it. I do not use though unless needed.

 

[Brandon O]

I love this stuff, but I really don't see the value here. With the accuracy of the test in mind, can you describe a scenario where it would change your care?

 

[abckidsmom]

I learned it in nursing school, haven't ever worked with a medic who knew about it. I don't use it because if I really suspect DVT, I minimize movement of the affected extremity, and if I really don't suspect DVT, a negative Homans sign doesn't necessarily mean anything other than that I suspected it enough to check for Homans sign.

Does that make sense?

 

[WTEngel]

The other thing to consider with low sensitivity / low specificity tests is that at some point, other clinical signs become more relevant and better at ruling in or out certain conditions.

If you have a woman using oral contraceptives complaining of lower limb pain/numbness/tingling, who just completed and 8 hour road trip, with alterations in color of the affected limb, DVT is very high on a short list of DDxs. If you got a negative Homan's sign in this patient, would you rule DVT out?

I guess the point I'm making is if you have enough in your HPI or H&P to even consider doing this test, a negative result should be viewed with due skepticism, and a positive result likely only coincides with what will be conclusively diagnosed by US later on.

Additionally, it poses an unnecessary risk to the patient and provides really no benefit whatsoever.

Field treatment is the same either way.

 

[Ewok Jerky]

If you have a woman using oral contraceptives complaining of lower limb pain/numbness/tingling, who just completed and 8 hour road trip, with alterations in color of the affected limb, DVT is very high on a short list of DDxs. If you got a negative Homan's sign in this patient, would you rule DVT out?

I guess the point I'm making is if you have enough in your HPI or H&P to even consider doing this test, a negative result should be viewed with due skepticism, and a positive result likely only coincides with what will be conclusively diagnosed by US later on.
.

if I may add/say it another way:

In this hypothetical Pt, her "pre-test" probability of DVT is high, which means with all the clinical data available she likely has a DVT. Its like "index of suspicion". Thus, if we get a negative Homan's Sign, it is likely to be a false negative. So, should we change our treatment? No of course not. Is our Pt still a high risk for DVT? Yes. If we get a positive Homan's Sign, we still put her at high risk of DVT.

Does this patient have deep vein thrombosis?
JAMA. 1998 Apr 8;279(14):1094-9.

Abstract
OBJECTIVE:
To review the validity of the clinical assessment and diagnostic tests in patients with suspected deep vein thrombosis (DVT).
METHODS:
A comprehensive review of the literature was conducted by searching MEDLINE from 1966 to April 1997.
RESULTS:
Individual symptoms and signs alone do not reliably predict which patients have DVT. Overall, the diagnostic properties of the clinical examination are poor; the sensitivity of the clinical examination ranges from 60% to 96%, and the specificity ranges from 20% to 72%. However, using specific combinations of risk factors, symptoms, and physical signs for DVT, clinicians can reliably stratify patients with suspected DVT into low, moderate, or high pretest probability categories of actually suffering from DVT. This stratification process in combination with noninvasive testing, such as compression ultrasonography, simplifies the management strategies for patients with suspected DVT.
CONCLUSIONS:
Use of a clinical prediction guide that includes specific factors from both the history and physical examination in combination with noninvasive tests simplifies management strategies for patients with suspected DVT.

 

[JPINFV]

There's a reason neither Wells DVT or PERC use Homan's sign.