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Wells score for DVT
Assigns a pre-test probability for deep vein thrombosis and sets the imaging and D-dimer sequence for a suspected DVT.
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What it is used for
The Wells score for DVT is the DVT arm of the NICE NG158 two-level pathway. Eight positive criteria each score 1, and one negative criterion — an alternative diagnosis at least as likely as DVT — subtracts 2, which is the item clinicians most often forget to apply. The total splits patients into 'DVT likely' and 'DVT unlikely', which then determines whether a proximal leg ultrasound is needed up front or only after a positive D-dimer.
The nine criteria
| Component | Points |
|---|---|
| Active cancerTreatment within 6 months | 1 |
| Paralysis, paresis, or recent plaster cast of the leg | 1 |
| Recently bedridden 3 days or more, or surgery within 4 weeks | 1 |
| Localised tenderness along the deep vein system | 1 |
| Entire leg swollen | 1 |
| Calf swelling 3 cm or more versus the asymptomatic leg | 1 |
| Pitting oedema confined to the symptomatic leg | 1 |
| Collateral superficial veinsNon-varicose | 1 |
| Alternative diagnosis at least as likely as DVT | −2 |
Note the final criterion subtracts two points.
How the score is interpreted
2 or more
DVT likely
Proximal leg ultrasound within 4 hours. If that is not available: D-dimer, interim parenteral anticoagulation, and ultrasound within 24 hours. If the scan is positive, anticoagulate.
1 or less
DVT unlikely
D-dimer. If negative, DVT is excluded — consider an alternative diagnosis. If positive, proceed to proximal leg ultrasound.
When not to use it
- The −2 criterion is frequently omitted, which inflates scores and over-investigates.
- The score addresses proximal DVT; it does not exclude isolated distal or pelvic vein thrombosis.
- Not validated in pregnancy or in recurrent DVT of the same leg.
Source: Wells DVT Score · NICE NG158 two-level pathway
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