We agree with Ginsberg and colleagues that clinicians "... should ensure the performance of serial IPG [impedance plethysmography] during a 7- to 14-day period if results of the initial test are normal."1 However, the authors' statement "... if a patient is considered to have a high clinical likelihood of DVT [deep-vein thrombosis] but has normal findings of IPG at presentation, further testing with venous ultrasonography or venography should be performed"1 is not justified based on their study design or results. Serial testing with IPG is an effective and safe approach for symptomatic patients with negative results of IPG at presentation.2-6 The safety of serial IPG testing in such patients has been established by five prospective studies2-6 that measured clinical outcome on follow-up. In these studies, none of the 1234 patients with serially negative IPG results died of pulmonary embolism, and only two patients (0.2%) had a symptomatic nonfatal
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