Pretest clinical probability scoring for DVT: the Wells score
In patients with symptoms in both legs, use the more symptomatic leg.
Clinical features
Score
Active cancer (treatment within last 6 months or palliative)
1
Paralysis, paresis, or recent plaster immobilisation of leg
1
Major surgery or recently bedridden for >3 days in last 4 weeks
1
Local tenderness along distribution of deep venous system
1
Entire leg swollen
1
Calf swelling >3cm compared to asymptomatic leg (measured 10cm below the tibial tuberosity)
1
Pitting oedema
1
Collateral superficial veins (non-varicose)
1
Alternative diagnosis as likely or more likely than that of DVT
-2
Score:
  • ≥3 points: High probability-treat as suspected DVT or perform compression US.
  • 1-2 points: Intermediate probability-treat as suspected DVT and perform compression US.
  • ≤0 points: Low probability of DVT-perform D-dimer test. If positive D-dimer then treat as suspected DVT and perform compression US. If negative D-dimer, DVT reliably excluded.
Adapted Well’s score for Pulmonary Embolism
Clinical features
Score
Clinical signs and symptoms of Deep Vein Thrombosis
3.0
PE is most likely diagnosis
3.0
Tachycardia (>100 bpm)
1.5
Immobilisation or surgery in the previous 4 weeks
1.5
Previously diagnosed DVT or PE
1.5
Haemoptysis
1.0
Malignancy (treatment within last 6 months or palliative)
1.0
Score:
  • ≥7 points: High probability
  • 2.0-6.0 points: Intermediate probability
  • 0-1 points: Low probability

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