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