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      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

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    Patent Pending

    Wells' Criteria for DVT

    Calculates risk of DVT based on clinical criteria.

    INSTRUCTIONS

    • Note: The Wells' Score is less useful in hospitalized patients (Silveira PC, 2015).
    • There are a few versions of this criteria with minor differences based on the study; this set is the most widely validated, based on Wells 2003.
    When to Use
    Pearls/Pitfalls
    Why Use

    The Wells’ DVT Criteria can be used in the outpatient and emergency department setting. By risk stratifying to low risk (Wells’ Score <2) and a negative d-dimer the clinician can exclude the need for ultrasound (US) to rule out DVT.

    The Wells’ Deep Vein Thrombosis (DVT) Criteria risk stratify patients for DVT.

    • There is an overall low prevalence of DVT in cases with low (<25%) clinical suspicion patients.
    • The Wells score inherently incorporates clinical gestalt with a minus 2 score for alternative diagnosis more likely.
    • Sequelae from DVT include pulmonary embolism (PE) and pulmonary hypertension, which have an associated mortality of 1-8%.
    • Anticoagulation is the mainstay treatment for DVT with its own associated risks of bleeding.

    Traditional testing for DVT involved multiple lower extremity US which are associated with time and cost. Utilization of the Wells’ DVT criteria can determine those patients who are overall unlikely to have a DVT. Further testing with d-dimer can safely rule out DVT without the need for US.

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    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Phil Wells

    From the Creator

    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.

    About the Creator

    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.

    To view Dr. Phil Wells's publications, visit PubMed

    Are you Dr. Phil Wells? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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