Wells Criteria /scoring for DVT
Present |
Score |
Lower limb trauma or surgery or immobilisation in a plaster cast |
+1 |
Bedridden for more than three days or surgery within the last four week |
+1 |
Tenderness along line of femoral or popliteal veins (NOT just calf tenderness) |
+1 |
Entire limb swollen |
+1 |
Calf more than 3cm bigger circumference,10cm below tibial tuberosity |
+1 |
Pitting oedema |
+1 |
Dilated collateral superficial veins (non-varicose) |
+1 |
Past Hx of confirmed DVT |
+1 |
Malignancy (including treatment up to six months previously) |
+1 |
Intravenous drug use |
+3 |
Alternative diagnosis as more likely than DVT |
-2 |
Pre-test Clinical probability of a DVT with score:
DVT "Likely" if Well's > 1
DVT "Unlikely" if Wells< 2
Wells criteria / scoring for PE
Present |
Score |
Clinical Signs and Symptoms of DVT? |
+3 |
PE is No. 1 Dx or Equally likley Dx |
+3 |
Heart Rate > 100 |
+1.5 |
Immobilization at least 3 days, or Surgery in the Previous 4 weeks |
+1.5 |
5 Previous, objectively diagnosed PE or DVT? |
+1.5 |
Haemoptysis? |
+1 |
Malignancy with treatment within 6 months, or palliative? |
+1 |
Pre-test clinical probability of a PE:
Wells Score > 4 - PE likely. Consider diagnostic imaging.
Wells Score 4 or less - PE unlikely. Consider D-dimer to rule out PE.
2003 BTS Guidelines - a practical approach to ? PE (not using the Wells criteria) are available in the PE page
References
- Wells PS, Owen C, Doucette S, Fergusson D, Tran H. Does this patient have deep vein thrombosis? JAMA. 2006 Jan 11;295(2):199-207.
- Scarvelis D, Wells PS. Diagnosis and treatment of deep-vein thrombosis. CMAJ. 2006 Oct 24;175(9):1087-92. Review. Erratum in: CMAJ. 2007 Nov 20;177(11):1392.
- Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, Kovacs G, Mitchell M, Lewandowski B, Kovacs MJ. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003 Sep 25;349(13):1227-35.
- Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000 Mar;83(3):416-20.
- Writing Group for the Christopher Study Investigators. Effectiveness of Managing Suspected Pulmonary Embolism Using an Algorithm Combining Clinical Probability, D-Dimer Testing, and Computed Tomography. JAMA. 2006;295:172-179.
