Well's scoring in VTE



Wells Criteria /scoring for DVT

Present

Score

Lower limb trauma or surgery or immobilisation in a plaster cast

+1

Bedridden for more than three days or surgery within the last four week

+1

Tenderness along line of femoral or popliteal veins (NOT just calf tenderness)

+1

Entire limb swollen

+1

Calf more than 3cm bigger circumference,10cm below tibial tuberosity

+1

Pitting oedema

+1

Dilated collateral superficial veins (non-varicose)

+1

Past Hx of confirmed DVT

+1

Malignancy (including treatment up to six months previously)

+1

Intravenous drug use

+3

Alternative diagnosis as more likely than DVT

-2

Pre-test Clinical probability of a DVT with score:

DVT "Likely" if Well's > 1
DVT "Unlikely" if Wells< 2


Wells criteria / scoring for PE

Present

Score

Clinical Signs and Symptoms of DVT?

+3

PE is No. 1 Dx or Equally likely Dx

+3

Heart Rate > 100

+1.5

Immobilization at least 3 days, or Surgery in the Previous 4 weeks

+1.5

5 Previous, objectively diagnosed PE or DVT?

+1.5

Haemoptysis?

+1

Malignancy with treatment within 6 months, or palliative?

+1

Pre-test clinical probability of a PE:

Wells Score > 4 - PE likely. Consider diagnostic imaging.
Wells Score 4 or less - PE unlikely. Consider D-dimer to rule out PE.

2003 BTS Guidelines - a practical approach to ? PE (not using the Wells criteria) are available in the PE page


References

  • Wells PS, Owen C, Doucette S, Fergusson D, Tran H. Does this patient have deep vein thrombosis? JAMA. 2006 Jan 11;295(2):199-207.
  • Scarvelis D, Wells PS. Diagnosis and treatment of deep-vein thrombosis. CMAJ. 2006 Oct 24;175(9):1087-92. Review. Erratum in: CMAJ. 2007 Nov 20;177(11):1392.
  • Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, Kovacs G, Mitchell M, Lewandowski B, Kovacs MJ. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003 Sep 25;349(13):1227-35.
  • Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000 Mar;83(3):416-20.
  • Writing Group for the Christopher Study Investigators. Effectiveness of Managing Suspected Pulmonary Embolism Using an Algorithm Combining Clinical Probability, D-Dimer Testing, and Computed Tomography. JAMA. 2006;295:172-179.

Content by Dr Íomhar O' Sullivan 30/07/2007. Last reviewed Dr ÍOS 22/11/18.