Should you chart negative human signs?

Should You Chart Negative Homan's Sign?

No, you should not routinely chart a negative Homan's sign, as it is neither sensitive nor specific for deep vein thrombosis (DVT) and has been largely abandoned in modern clinical practice due to its poor diagnostic accuracy and potential to provide false reassurance.

Why Homan's Sign Should Not Be Documented

Poor Diagnostic Performance

• Homan's sign (calf pain with dorsiflexion of the foot) has been demonstrated to have extremely poor sensitivity (10-54%) and specificity (39-89%) for detecting DVT, making it clinically unreliable for ruling in or ruling out disease 1
• The presence or absence of individual clinical signs and symptoms, including Homan's sign, are not accurate enough to rule in or rule out thrombotic disease 1

Risk of False Reassurance

• Documenting a negative Homan's sign may create false reassurance and delay appropriate diagnostic testing (such as D-dimer or ultrasound) in patients with actual DVT 1
• Clinical assessment should focus on validated risk stratification tools (such as Wells' criteria) rather than unreliable physical examination findings 1

What Should Be Documented Instead

Appropriate Clinical Documentation

• Document objective vital signs and validated assessment tools rather than outdated physical examination maneuvers 2
• Record relevant clinical findings that contribute to validated prediction rules: unilateral leg swelling, localized tenderness along deep venous system, entire leg swelling, collateral superficial veins, previous documented DVT 1
• Use standardized assessment scales and physiological track-and-trigger systems (such as NEWS) for monitoring acutely unwell patients 2

Time-Based Documentation Standards

• All clinical documentation should include time-based records with specific measurements rather than subjective or unreliable signs 2
• Focus on documenting findings that have established diagnostic value and contribute to evidence-based clinical decision-making 2

Common Pitfalls to Avoid

Documentation Errors

• Avoid documenting physical examination findings that lack established validity or reliability, as this clutters the medical record without adding clinical value 2
• Do not rely on negative findings of unreliable tests to exclude serious diagnoses—this represents a significant patient safety risk 1

Clinical Decision-Making

• Never use the absence of Homan's sign to rule out DVT or to avoid ordering appropriate diagnostic testing when clinical suspicion exists 1
• Recognize that measurement error exists even with validated scales (inter-rater reliability typically 0.85-0.9), making unreliable signs even more problematic 2