Wells clinical prediction rules for DVT
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Indications
- predicting risk of DVT
- outpatient assessment of need for ultrasound to rule out DVT
- not useful in inpatient setting
Principle
- each of the following earns 1 point
- previously documented DVT
- active cancer or treatment within 6 months
- paralysis, paresis or recent plaster cast
- recent immobilization or recent surgery
- tenderness along the deep veins
- swelling of the whole leg
- > 3 cm difference in calf circumference compared to other leg
- unilateral pitting edema
- collateral superficial veins (swollen unilateral superficial veins)
- if alternative diagnosis is likely, subtract 2 points*
* there are no positive points for no alternative diagnosis[5]
Clinical significance
- does not perform as well as plasma D-dimer
- performs slightly poorer the primary care rule for DVT[2]
- misses 1.6% of DVTs identified by ultrasound[2]
- in patients with cancer or history of DVT, Well's rule alone cannot exclude DVT: negative D-dimer needed for exclusion[3]
Interpretation
- a score > 3 suggests high probability of DVT
- a score of 1-3 suggests an intermediate probability
- if alternative diagnosis as likely, need at least 3 of the above criteria[2]
Management
- patients with low probability Wells score should have plasma D-dimer testing; no imaging necessary if results are normal
- patients with high probability Wells score should undergo imaging without plasma D-dimer testing
More general terms
References
- ↑ Journal Watch 25(17):137, 2005 Goodacre S, Sutton AJ, Sampson FC. Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis. Ann Intern Med. 2005 Jul 19;143(2):129-39. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16027455
Oudega R, Hoes AW, Moons KG. The Wells rule does not adequately rule out deep venous thrombosis in primary care patients. Ann Intern Med. 2005 Jul 19;143(2):100-7. Summary for patients in: Ann InterN Med. 2005 Jul 19;143(2):I27. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16027451
Douketis JD. Use of a clinical prediction score in patients with suspected deep venous thrombosis: two steps forward, one step back? Ann Intern Med. 2005 Jul 19;143(2):140-2. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16027456 - ↑ 2.0 2.1 2.2 2.3 van der Velde EF, Toll DB, ten Cate-Hoek AJ et al Comparing the Diagnostic Performance of 2 Clinical Decision Rules to Rule Out Deep Vein Thrombosis in Primary Care Patients Annals of Family Medicine 9:31-36 (2011) <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21242558 <Internet> http://www.annfammed.org/cgi/content/full/9/1/31
- ↑ 3.0 3.1 Geersing GJ et al Exclusion of deep vein thrombosis using the Wells rule in clinically important subgroups: individual patient data meta-analysis. BMJ 2014;348:g1340 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24615063 <Internet> http://www.bmj.com/content/348/bmj.g1340
- ↑ Silveira PC et al. Performance of Wells score for deep vein thrombosis in the inpatient setting. JAMA Intern Med 2015 Jul 1; 175:1112 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25985219
- ↑ 5.0 5.1 Medical Knowledge Self Assessment Program (MKSAP) 15, 17, 18. American College of Physicians, Philadelphia 2009, 2015, 2018.