In contrast to the geneva score, the modified wells score has one subjective component that asks if the clinician believes that pe is the most likely diagnosis or. Wells clinical prediction rule for pe produces a point score based on clinical features and the likelihood of diagnoses other than pe. The 2 scoring systems available to stratify the patients risk of pe are. Calf swelling 3 cm greater than other leg measured 10 cm below the tibial tuberosity. Nuclear grade iii or iv based on fuhrman criteria 5 mitotic figures50 hpf 40x objective, counting 10 random fields in area of greatest number of mitotic figures on 5 slides with greatest number of mitoses. The dvt probability wells score system calculator evaluates the following clinical criteria. The original and modified wells score are widely used prediction rules for pretest probability assessment of deep vein thrombosis dvt. High suspicion for dvt should warrant imaging regardless of wells score. The wells criterion is a clinically validated scoring system in an outpatient setting, but its use in trauma patients has not been studied. This guidance has been updated and replaced by nice guideline ng158.
Patients with suspected pe should undergo a twolevel pe wells score and receive a ctpa if scored likely or ddimer testing if there is a low pretest probability score. How is the ddimer test used in the diagnosis of dvt. The score aids in potentially reducing the number of ctas performed on lowrisk pe patients. Depending on the pretest probability wells score they should then either proceed to twopoint ultrasound scanning or ddimer testing. Pe not using the wells criteria are available in the pe page. The objective of this study was to compare the predictive performance of both wells scores in unselected patients with clinical suspicion of dvt. Using this score, your doctor can determine your likelihood of having dvt. Paralysis, paresis or recent orthopedic casting of lower extremity. Dvt happens when a blood clot forms in a vein thats deep inside your body, usually in your leg. There is an overall low prevalence of dvt in cases with low clinical gestalt with a minus 2 score for alternative diagnosis more likely.
In patients with suspected recurrent events, only the modified wells rule adding one point for the previous event is safe. The wells criteria for dvt is utilized for the workup of dvt. The modified wells score accurately excludes pulmonary. The twolevel wells scores should be used in suspected vte. Effectiveness of managing suspected pulmonary embolism using an. The only exception is that answering yes to the final question results in the subtraction of two points from the total score. The prevalence of pe in hospitalized patients receiving prophylactic heparin is lower than in cohorts from which the wells prediction criteria were derived and validated. We used seven scoring systems original geneva score, revised geneva score, simplified geneva score, wells score, simplified wells score, simplified charlotte rule, pisa model to assess the clinical probability of pe in 41 patients with suspected pulmonary embolism for whom the final diagnosis was based on multislice ct pulmonary angiography ctpa. Values of the wells and revised geneva scores combined with d. The wells score or wells criteria can refer to one of two clinical prediction rules in clinical medicine. Assessment for pulmonary embolism clinic, hospital medicine when to use. Caprini risk assessment model for venous thromboembolism. Name todays date only your doctor can determine if you are at risk for deep vein thrombosis dvt, a blood clot that forms in one of the deep veins of. Conclusion combined with a negative ddimer test result both quantitative and qualitative, deep vein thrombosis can be excluded in.
Mandatory assignment of modified wells score before ct. The wells dvt criteria can be used in the outpatient and emergency department setting. Which one of the following describes the gold standard for diagnosis of dvt used in this. By risk stratifying to low risk wells score wells criteria for dvt. Respiratory pe scoring systems wells score modified. Main outcomes and measures our primary outcome was the wells scores utility for risk stratification among inpatients with suspected dvt as measured by the difference in incidence of proximal dvt among the 3 wells score categories low, moderate, and high pretest probability, the discrimination accuracy of the wells score categories as the. Pdf clinical utility of the modified wells score in. Wells score was used to define each patients probability of developing dvt, patients were assigned a score and then categorized. Initial studies support the validity of these scores. In contrast to the geneva score, the modified wells score has one subjective component that asks if the clinician believes that pe is the most likely diagnosis or is at least as likely as any other diagnosis. Add up all points to reach your total dvt risk score. The modified wells score was selected in spite of its greater subjectivity than the geneva score. Physicians have a low threshold to test for pulmonary embolism. The wells deep vein thrombosis dvt criteria risk stratify patients for dvt.
The modified wells score is a score out of 9 based on risk factors such as recent surgery and malignancy as well as findings on clinical examination. Exclusion of deep vein thrombosis using the wells rule in. Clinical probability of pulmonary embolism adapted from van belle a et al. Pdf assessment of wells criteria in patients with pulmonary. Original weiss criteria for malignancy am j surg pathol 1984. Pulmonary embolism wells score calculator medscape reference. Caprini risk assessment model for venous thromboembolism complete the risk assessment to determine your patients risk level for venous thromboembolism vte. Among the patient group with modified wells criteria, 36 patients 36.
The wells criteria for dvt objectifies risk of deep vein thrombosis dvt based on clinical findings. Wells scoring categorizes evaluated patients into one of the low 0 or less point, moderate 1 or 2 points, and high 3 or greater points probability. Adapted from wells et al, evaluation of ddimer in the diagnosis of suspected deepvein thrombosis. Some advocate using the wells score over clinician gestalt to predict who is lowrisk and then applying the perc rule to stop workup for pe. The score is simple to use and provides clear cutoffs for the predicted probability of pulmonary embolism. Comparison of the diagnostic performance of the original. Useful testing modality when ct is contraindicated or additional testing is needed. Pulmonary embolism pe is one of the most important. The wells score has been validated multiple times in multiple clinical settings. Active cancer 3 days because of symptoms within 4 weeks 1pt ttp along deep venous system 1pt entire leg swollen 1pt. Pulmonary embolism probability scoring for diagnosing pulmonary embolism. Wells score was calculated using s online calculator. Your wells score is calculated based on several factors. Diagnostic prediction models for suspected pulmonary.
Hamilton score, modified wells score, ddimer, doppler examination of veins, unilateral complete lower limb ultrasonography with doppler exam used as guide, telephone survey 3 months later to identify symptoms of venous thromboembolism 2. Answering yes to any of the below questions results in adding 1 point to the total score. Can be applied for patients whose clinical presentation is concerning for a dvt in order to risk stratify. Modified wells criteria criterion score clinical signs or symptoms of dvt 3 alternative diagnosis less likely than pe 3 heart rate 100 beats per minute 1. Wells criteria for dvt is a reliable clinical tool to. Recently bedridden more than 3 days or major surgery within past 4 weeks. Values of the wells and revised geneva scores combined with ddimer in diagnosing elderly pulmonary embolism patients. Add 1 point for each of the following statements that apply. The wells criteria risk stratifies patients for pulmonary embolism pe and provides an estimated pretest probability. Dvt probability scoring for diagnosing deep vein thrombosis. Clinical probability of deep vein thrombosis adapted from wells et al, evaluation of ddimer in the diagnosis of suspected deepvein thrombosis. Venous duplex surveillance is used widely for the diagnosis of dvt, however, there is controversy concerning its appropriate use.