The problem here is a lack of credible data surrounded by a distinct feeling that all may not be as the current scanty data suggest.
Unless a well designed survey is implemented that situation will continue.
Postal surveys have response rates of 20% under IDEAL circumstances - it's usually around 10-12%. Death rates for untreated vs treated DVTs relate to in hospital or condition specific DVTs and cannot be extrapolated to the population under discussion here.
The choice of diagnostic test for DVT is paramount: a postal survey of Family Docs, with all due respect to you and them, simply is a non-starter. What types of DVT do you want to hunt for? Iodinated fibrinogen scans cost - even a Doppler U/s is expensive and are thought to be less sensitive for popliteal or distal DVTs - they are best suited for the potentially lethal proximal clots. Are you interested in all DVTS or just the potentially lethal? Some would argue that ascending venography is the gold standard assessment for DVT - who would finance that?
What is the role, if any, of a sudden return to activity -eg. the Baggage wrestle - in the presence of DVT, particularly in the young and more active population?
What other coexistent risk factors might confound the issue - the Pill, smoking, dehydration &c? These could each be addressed if only the design of the study is well thought out.
Whichever perspective you come from, a bullet-proof study is needed. The money is as always the key - you get what you pay for. Over the years I have also realised that the piper calls the tune and I have grave reservations that a major carrier would design deliberately, a study which would have even a slight chance of showing it's service needs a health warning.
It is going to cost and I cannot see anyone who both can and wants to afford it.
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[This message has been edited by Code Blue (edited 07 January 2001).]
edited for Sunday Morning dyslexia
[This message has been edited by Code Blue (edited 07 January 2001).]