Wells Score for DVT Diagnosis

CPD
1m

Transcript

The Wells score for the diagnosis of a DVT.

The Wells score is the most widely used clinical decision tool for the diagnosis of deep vein thrombosis (DVT). This tool risk-stratifies patients into 'low', 'intermediate' and 'high' risk categories for DVT, based on a point system.

A score of less than two indicates low risk, and above two indicates intermediate/high risk.

Criteria Score
Active cancer (patient receiving treatment for cancer within 6 months or currently receiving palliative treatment). +1
Paralysis, paresis, or recent plaster or immobilisation of the lower extremeties. +1
Recently bedridden for 3 days or more, or major surgery within the previous 12 weeks requiring regional anaesthesia. +1
Localised tenderness along the distribution of the deep venous system. +1
Entire leg swollen. +1
Calf swelling at least 3cm larger than that on asymptomatic side (measured 10cm below tibial tuberosity). +1
Pitting oedema confied to the symptomatic leg. +1
Collateral superficial veins (non-varicose). +1
Previously documented deep vein thrombosis. +1
Alternative diagnosis at least as likely as deep vein thrombosis. -2

The tool assists the clinician in deciding if the patient requires a duplex ultrasound scan to exclude DVT. In patients with a Wells score of less than two, a whole blood D dimer assay should be performed to exclude a DVT safely.

If the D dimer assay is positive they will require a compression ultrasound. A score above two on the Wells score criteria also means the patient requires a compression ultrasound. If positive, treatment for DVT should be initiated.
Details
CPD1m of CPD
First Published14 April 2020
Updated14 April 2020
Expires
15 April 2023
Topics
Thrombosis
Pulmonary Care
Clinical Assessment
Diagnostic Tools
Learning Tools