
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