Wells score for DVT (original): Difference between revisions

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'''Editor(s)-In-Chief:''' {{ATI}}, [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; {{AE}} [[Kashish Goel|Kashish Goel, M.D.]], [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu], {{SSH}}
__NOTOC__
{{hatnote|For other versions of Wells score, click [[Wells score|'''here''']]}}


==Wells score Calculator==
{{CMG}} {{AE}} {{SSH}}, Kashish Goel, M.D., [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu]


This handy calculator computes the pre-test probability of [[deep vein thrombosis|deep vein thrombosis (DVT)]] using Wells criteria. Check all boxes that apply to your patient:
==Overview==
{{#widget:DVT_calculator}}


'''Interpretation'''
== Wells Score Calculator for DVT ==
* Score:
This handy calculator computes the pre-test probability of [[deep vein thrombosis|deep vein thrombosis (DVT)]] using Wells criteria.<ref name="pmid14507948">{{cite journal |vauthors=Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, Kovacs G, Mitchell M, Lewandowski B, Kovacs MJ |title=Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis |journal=N. Engl. J. Med. |volume=349 |issue=13 |pages=1227–35 |date=September 2003 |pmid=14507948 |doi=10.1056/NEJMoa023153 |url=}}</ref><ref name="pmid17060659">{{cite journal |vauthors=Scarvelis D, Wells PS |title=Diagnosis and treatment of deep-vein thrombosis |journal=CMAJ |volume=175 |issue=9 |pages=1087–92 |date=October 2006 |pmid=17060659 |pmc=1609160 |doi=10.1503/cmaj.060366 |url=}}</ref><ref name="pmid16403932">{{cite journal |vauthors=Wells PS, Owen C, Doucette S, Fergusson D, Tran H |title=Does this patient have deep vein thrombosis? |journal=JAMA |volume=295 |issue=2 |pages=199–207 |date=January 2006 |pmid=16403932 |doi=10.1001/jama.295.2.199 |url=}}</ref><ref name="pmid22315267">{{cite journal |vauthors=Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD, Kearon C, Schunemann HJ, Crowther M, Pauker SG, Makdissi R, Guyatt GH |title=Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines |journal=Chest |volume=141 |issue=2 Suppl |pages=e351S–e418S |date=February 2012 |pmid=22315267 |pmc=3278048 |doi=10.1378/chest.11-2299 |url=}}</ref><ref name="pmid25985219">{{cite journal |vauthors=Silveira PC, Ip IK, Goldhaber SZ, Piazza G, Benson CB, Khorasani R |title=Performance of Wells Score for Deep Vein Thrombosis in the Inpatient Setting |journal=JAMA Intern Med |volume=175 |issue=7 |pages=1112–7 |date=July 2015 |pmid=25985219 |doi=10.1001/jamainternmed.2015.1687 |url=}}</ref>


** ≤ 0- Low probability of DVT: Prevalence = 5%, [[Deep vein thrombosis diagnosis algorithm|Consider checking D-dimer]]
Check all boxes that apply to your patient:
{{#Widget:DVT_Wells_score_calculator}}
== Interpretation ==
The interpretation of the score is as follows:
* Score ≥3: High pretest probability (Prevalence of DVT - 75%)
* Score 1-2: Moderate pretest probability (Prevalence of DVT - 17%)
* Score ≤0: Low pretest probability (Prevalence of DVT - 3%)
== Limitations of Wells Score ==
* The accuracy of the Wells rule, though useful in secondary and tertiary care centers, has not been properly validated for use in primary care patients with the suspicion of DVT.<ref name="pmid160274512">{{cite journal |vauthors=Oudega R, Hoes AW, Moons KG |title=The Wells rule does not adequately rule out deep venous thrombosis in primary care patients |journal=Ann. Intern. Med. |volume=143 |issue=2 |pages=100–7 |date=July 2005 |pmid=16027451 |doi= |url=}}</ref>
* The performance of the Wells score was decreased when evaluating elderly patients, patients with a prior DVT, or patients having other comorbidities. These results may be equivalent to what is found in a primary care setting. Also, it should be highlighted that Wells criteria is an additional tool to diagnosis rather than being a stand-alone test.<ref name="pmid160274552">{{cite journal |vauthors=Goodacre S, Sutton AJ, Sampson FC |title=Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis |journal=Ann. Intern. Med. |volume=143 |issue=2 |pages=129–39 |date=July 2005 |pmid=16027455 |doi= |url=}}</ref><ref name="pmid17261865">{{cite journal |author=Qaseem A, Snow V, Barry P, Hornbake ER, Rodnick JE, Tobolic T, Ireland B, Segal J, Bass E, Weiss KB, Green L, Owens DK |title=Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians |journal=Ann Fam Med |volume=5 |issue=1 |pages=57–62 |year=2007 |pmid=17261865|pmc=1783928 |doi=10.1370/afm.667|url=http://www.annfammed.org/cgi/pmidlookup?view=long&pmid=17261865 |accessdate=2011-12-22}}</ref>


** 1-2 - Moderate probability of DVT: Prevalence = 17%, [[Deep vein thrombosis diagnosis algorithm|Consider checking D-dimer]]
==See also==
* [[Wells score for DVT (modified)]]
* [[Wells score for PE (original)]]
* [[Wells score for PE (modified)]]
* [[Deep vein thrombosis assessment of clinical probability and risk scores]]
* [[Pulmonary embolism assessment of clinical probability and risk scores]]


** ≥ 3 - High probability of DVT: Prevalence = 53%, [[Deep vein thrombosis diagnosis algorithm|Consider imaging of the deep veins]]
==References==
{{Reflist|2}}
 
[[Category:Medicine]]
[[Category:Cardiology]]
[[Category:Hematology]]
[[Category:Up-To-Date]]
[[Category:Calculator]]

Latest revision as of 00:43, 30 July 2020

For other versions of Wells score, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2], Kashish Goel, M.D., Kristin Feeney, B.S. [3]

Overview

Wells Score Calculator for DVT

This handy calculator computes the pre-test probability of deep vein thrombosis (DVT) using Wells criteria.[1][2][3][4][5]

Check all boxes that apply to your patient:

Wells Score Calculator for DVT
Variable Score
Active cancer (treatment within last 6 months or palliative) 1
Calf swelling >3 cm compared to other calf (measured 10 cm below tibial tuberosity) 1
Collateral superficial veins (non-varicose) 1
Pitting edema (confined to symptomatic leg) 1
Swelling of entire leg 1
Localized pain along distribution of deep venous system 1
Paralysis, paresis, or recent cast immobilization of lower extremities 1
Recently bedridden > 3 days, or major surgery requiring regional or general anesthetic in past 12 weeks 1
Alternative diagnosis at least as likely -2
Wells Score:
Interpretation:

Interpretation

The interpretation of the score is as follows:

  • Score ≥3: High pretest probability (Prevalence of DVT - 75%)
  • Score 1-2: Moderate pretest probability (Prevalence of DVT - 17%)
  • Score ≤0: Low pretest probability (Prevalence of DVT - 3%)

Limitations of Wells Score

  • The accuracy of the Wells rule, though useful in secondary and tertiary care centers, has not been properly validated for use in primary care patients with the suspicion of DVT.[6]
  • The performance of the Wells score was decreased when evaluating elderly patients, patients with a prior DVT, or patients having other comorbidities. These results may be equivalent to what is found in a primary care setting. Also, it should be highlighted that Wells criteria is an additional tool to diagnosis rather than being a stand-alone test.[7][8]

See also

References

  1. ↑ Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, Kovacs G, Mitchell M, Lewandowski B, Kovacs MJ (September 2003). "Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis". N. Engl. J. Med. 349 (13): 1227–35. doi:10.1056/NEJMoa023153. PMID 14507948.
  2. ↑ Scarvelis D, Wells PS (October 2006). "Diagnosis and treatment of deep-vein thrombosis". CMAJ. 175 (9): 1087–92. doi:10.1503/cmaj.060366. PMC 1609160. PMID 17060659.
  3. ↑ Wells PS, Owen C, Doucette S, Fergusson D, Tran H (January 2006). "Does this patient have deep vein thrombosis?". JAMA. 295 (2): 199–207. doi:10.1001/jama.295.2.199. PMID 16403932.
  4. ↑ Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD, Kearon C, Schunemann HJ, Crowther M, Pauker SG, Makdissi R, Guyatt GH (February 2012). "Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e351S–e418S. doi:10.1378/chest.11-2299. PMC 3278048. PMID 22315267.
  5. ↑ Silveira PC, Ip IK, Goldhaber SZ, Piazza G, Benson CB, Khorasani R (July 2015). "Performance of Wells Score for Deep Vein Thrombosis in the Inpatient Setting". JAMA Intern Med. 175 (7): 1112–7. doi:10.1001/jamainternmed.2015.1687. PMID 25985219.
  6. ↑ Oudega R, Hoes AW, Moons KG (July 2005). "The Wells rule does not adequately rule out deep venous thrombosis in primary care patients". Ann. Intern. Med. 143 (2): 100–7. PMID 16027451.
  7. ↑ Goodacre S, Sutton AJ, Sampson FC (July 2005). "Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis". Ann. Intern. Med. 143 (2): 129–39. PMID 16027455.
  8. ↑ Qaseem A, Snow V, Barry P, Hornbake ER, Rodnick JE, Tobolic T, Ireland B, Segal J, Bass E, Weiss KB, Green L, Owens DK (2007). "Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians". Ann Fam Med. 5 (1): 57–62. doi:10.1370/afm.667. PMC 1783928. PMID 17261865. Retrieved 2011-12-22.
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