Neher md university of washington the following is a copy of an article from evidencebased practice, 2007. Shortness of breath sudden chest pain a feeling of apprehension sudden collapse coughing sweating bloody phlegm coughing up blood. There is an overall low prevalence of dvt in patients where there is low 3 days because of symptoms within 4 weeks 1pt ttp along deep venous system 1pt entire leg swollen 1pt. Paralysis, paresis or recent orthopedic casting of lower extremity. By risk stratifying to low risk wells score wells criteria for dvt. The wells score inherently incorporates clinical gestalt with a minus 2 score for alternative diagnosis more likely. Mra was sensitive and specific in detecting acute pe. The wells criteria for dvt objectifies risk of deep vein thrombosis dvt based on clinical findings. Contraindications to dvt prophylaxis active or high risk of bleeding therapeutic anticoagulation thrombocytopenia platelets 1. Paralysis, paresis or recent immobilization of le 1 3. Pdf wells criteria for dvt is a reliable clinical tool. The wells score for dvt 27 is the best known clinical probability assessment tool for clinically suspected dvt. Performance of wells score for deep vein thrombosis in the. Alternative diagnosis as likely or greater than that of proximal dvt.
Calf swelling 3 cm greater than other leg measured 10 cm below the tibial tuberosity. Twolevel wells score tables and algorithms for diagnosis deep vein thrombosis dvt table 1 twolevel dvt wells scorea clinical feature points active cancer treatment ongoing, within 6 months, or palliative 1 paralysis, paresis or recent plaster immobilisation of the lower extremities 1 recently bedridden for 3 days or more or major surgery. More than 8 million inpatients have a high risk for deep vein thrombosis dvt annually in the united states, with potentially fatal complications such as pulmonary embolism. The aim of our prospective study was to assess the accuracy of the wells scale in primary care setting in diagnostic procedure of suspected deep vein thrombosis. Wells criteria for dvt is a reliable clinical tool to assess the risk of deep venous thrombosis in trauma patients article pdf available in world journal of emergency surgery 111 december. Performance of wells score for deep vein thrombosis in the inpatient setting. Sequelae from dvt include pulmonary embolism pe and pulmonary hypertension, which have an associated mortality of 18%. Effectiveness of managing suspected pulmonary embolism using an.
Wells score for inpatient deep vein thrombosis journal. Pain associated with dvt is often described as being a. The authors concluded that the wells score risk stratification is not sufficient to rule out dvt or influence management decisions in the inpatient setting. Wells score in the diagnosis of lower extremity deep vein thrombosis compared. Deep vein thrombosis dvt is a common complication in trauma patients. Twolevel dvt wells score clinical feature points patient score active cancer treatment ongoing, within 6 months, or palliative 1 paralysis, paresis or recent plaster immobilisation of the lower extremities 1 recently bedridden for 3 days or more or major surgery within. Silveira pc 1, ip ik 1, goldhaber sz 2, piazza g 2, benson cb 3, khorasani r 4. Physicians have a low threshold to test for pulmonary embolism.
Agreement between consultant and nurse practitioner. Diagnosis of dvt with ddimer testing and the wells score july 2010 jon o. Answering yes to any of the below questions results in adding 1 point to the total score. The wells score has been validated multiple times in multiple clinical settings. Deep vein thrombosis should be suspected in any patient who presents with unexplained extremity swelling, pain, warmth or erythema. There are several other scoring systems for estimating dvt risk, but the wells dvt score is the best studied. Diagnosis of dvt with ddimer testing and the wells score. Clinical probability of deep vein thrombosis wells. Wells clinical prediction rule optim manual therapy. Interrater reliability of the wells score as part of the. Anyone may be at risk for dvt but the more risk factors you have, the greater your chances are of developing dvt.
The clinical picture of deep vein thrombosis dvt is nonspecific. Pe can be fatal, if you experience these signs or symptoms. Venous duplex surveillance is used widely for the diagnosis of dvt. Anticoagulation is the mainstay treatment for dvt with its own associated risks of bleeding. The dvt probability wells score system calculator evaluates the following clinical criteria. The score aids in potentially reducing the number of ctas performed on lowrisk pe patients. The wells score is a number that reflects your risk of developing deep vein thrombosis dvt.
Pdf on jan 1, 2019, manal khudder and others published a comparison between. Screen for suspected dvt using the twolevel wells dvt score and possibly ddimer. It is a straightforward pointscore system with a maximum of eight score points, with one point each given for 1 cancer, 2 paralysis or recent plaster cast, 3 bed rest longer than 3 days or surgery in the previous 4 weeks, 4 pain. Clinical probability of pulmonary embolism adapted from van belle a et al.
Clinical probability of deep vein thrombosis adapted from wells et al, evaluation of ddimer in the diagnosis of suspected deepvein thrombosis. The most common site for deep venous thrombosis is in the deep veins of the legs and thighs. Recently bedridden more than 3 days or major surgery within past 4 weeks. If wells ptp score is low dvt refers to the formation of a blood clot in the deep venous system, a network of large veins with extensive branching that covers the whole body. Deep vein thrombosis dvt common signs and symptoms of pe. To add to the confusion, wells and his colleagues have made continuous improvements over time, such that there are several versions of the wells dvt score. The authors concluded that the wells score performed only slightly better than chance for discrimination of dvt risk in hospitalized patients. Clinical probability of deep vein thrombosis adapted from wells et al, evaluation of ddimer in the diagnosis of suspected deep vein thrombosis. Suspected dvt can now be managed by the general practitioner. Twolevel dvt wells score clinical feature points patient score active cancer treatment ongoing, within 6 months, or palliative 1 paralysis, paresis or recent plaster immobilisation of the lower extremities 1 recently bedridden for 3 days or more or major surgery within 12 weeks requiring general or regional anaesthesia 1. Pe not using the wells criteria are available in the pe page. The only exception is that answering yes to the final question results in the subtraction of two points from the total score.