Wells DVT Criteria

The Wells DVT Criteria is used to assess the risk of deep vein thrombosis (DVT). Points are given for certain risk factors, with the total score indicating the likelihood of DVT. The total score can range from -2 to 9. A score of 2 or higher indicates a high probability of DVT, 1 to 1 indicates moderate probability, and 0 or lower indicates low probability. This scoring system is intended to be used alongside diagnostic testing, such as D-dimer tests and ultrasound, to guide the management of patients with suspected DVT

Calculation

A sum of points is calculated based on the presence of the following risk factors:

• Lower limb trauma, surgery, or plaster immobilization: 1 point
• Immobilization or recent surgery: 1 point
• Tenderness along the deep venous system: 1 point
• Entire leg swelling: 1 point
• Calf swelling >3 cm compared to the asymptomatic leg: 1 point
• Pitting edema, confined to the symptomatic leg: 1 point
• Collateral nonvaricose superficial veins: 1 point
• Previously documented DVT: 1 point
• Active cancer: 1 point
• Paralysis, paresis, or recent plaster immobilization: 1 point
• Recently bedridden >3 days or major surgery within 4 weeks: 1 point
• Alternative diagnosis as likely or more likely than DVT: -2 points

Scoring

• ≥2 points: High probability of DVT
• 1 point: Moderate probability of DVT
• 0 or below: Low probability of DVT

Considerations

• There are considerations regarding the effectiveness of the Wells criteria for inpatients and patients with a history of cancer.
• The combination of the Wells score and D-dimer may not be appropriate for evaluation in patients with a history of cancer.
• Pretest clinical probability with the Wells score may have a low diagnostic accuracy for isolated distal DVT.
• Scores should be used in conjunction with diagnostic tests such as D-dimer and ultrasound (as appropriate) to guide patient management.

References

• Goodacre, S., Sutton, A. J., & Sampson, F. C. (2005). Meta-analysis: the value of clinical assessment in the diagnosis of deep venous thrombosis. Annals of Internal Medicine, 143(2), 129-139.
• Wells, P. S., Owen, C., Doucette, S., Fergusson, D., & Tran, H. (2006). Does this patient have deep vein thrombosis?. Jama, 295(2), 199-207.
• Radiopaedia.org - Wells criteria for deep venous thrombosis