Wells' Criteria for DVT

Dr. Wells on use of his scores for MDCalc:

The model should be applied only after a history and physical suggests that venous thromboembolism is a diagnostic possibility. it should not be applied to all patients with chest pain or dyspnea or to all patients with leg pain or swelling. This is the most common mistake made. Also, never never do the D-dimer first [before history and physical exam]. The monster in the box is that the D-dimer is done first and is positive (as it is for many patients with non-VTE conditions) and then the physician assumes that VTE is now possible and then the model is done. Do the history and physical exam first and decide if VTE is a diagnostic possibility!

Dr. Wells on testing in medicine for MDCalc:

The importance of Clinical pretest probability is underutilized in medicine. Recognizing the power of a simple concept, derived essentially from Bayes theorem, that discordance between the clinical PTP and the test result should raise suspicion of a false negative test (if high PTP) or false positive test (if low PTP), we sought to derive prediction rules for suspected DVT and for suspected PE. Used appropriately these rules will improve patient care.

Phil Wells, MD, MSc, is a professor and chief of the Department of Medicine at The University of Ottawa. He is also on the faculty of medicine and a senior scientist at the Ottawa Hospital Research Institute. Dr. Wells researches thromboembolism, thrombophilia and long term bleeding risk in patients on anticoagulants.