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Wells DVT

Pre-test probability for DVT

Indication

  • Pre-test probability for DVT

Criteria

  • id: cancer; label: Active cancer (treatment within 6 months or palliative); type: yesno; points: 1
  • id: paralysis; label: Paralysis/paresis/recent cast on lower extremity; type: yesno; points: 1
  • id: bedrest; label: Bedridden >3 days or major surgery within 12 weeks; type: yesno; points: 1
  • id: tenderness; label: Localized tenderness along deep venous system; type: yesno; points: 1
  • id: swelling; label: Entire leg swollen; type: yesno; points: 1
  • id: calf; label: Calf swelling >3cm compared to asymptomatic side; type: yesno; points: 1
  • id: pitting; label: Pitting edema confined to symptomatic leg; type: yesno; points: 1
  • id: collateral; label: Collateral superficial veins (non-varicose); type: yesno; points: 1
  • id: prior; label: Previously documented DVT; type: yesno; points: 1
  • id: alternative; label: Alternative diagnosis at least as likely as DVT; type: yesno; points: -2

Interpretation

  • function(score) { if (score <= 0) return { risk: score + ' points', tier: 'Low Probability', action: 'DVT probability ~5%. Check D-dimer. If negative, DVT excluded.', color: 'green' }; if (score <= 2) return { risk: score + ' points', tier: 'Moderate Probability', action: 'DVT probability ~17%. Check D-dimer. If positive, proceed to ultrasound.', color: 'yellow' }; return { risk: score + ' points', tier: 'High Probability', action: 'DVT probability ~53%. Proceed directly to compression ultrasound.', color: 'red' }; }

Clinical pearls

  • Low probability + negative D-dimer effectively excludes DVT
  • High probability: go straight to ultrasound — do NOT rely on D-dimer
  • The alternative diagnosis criterion (-2 points) is subjective but important
  • Age-adjusted D-dimer (age x 10 for >50y) improves specificity

Source and review

  • Wells et al., Lancet 1997, NEJM 2003. Last reviewed: 2024-10-15