Deep vein thrombosis, wells score

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

wells score; Wells Score

Definition
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Score that allows an assessment of the clinical probability of the presence of a thromboembolism based on clinical and anamnestic parameters.

General information
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For the diagnosis of thromboembolic events, the D-dimer determination has a high diagnostic sensitivity (even more so in pulmonary embolism than in deep vein thrombosis - DVT) but a low specificity. Thus, although a low value means that a thromboembolic event can be ruled out with a high probability (high negative predictive value), an increased value is often more difficult to classify. In this case, the combination of the D-dimer determination with the so-called "Wells-Score" (named after P.S. Wells) is recommended.

Implementation
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Determination of the clinical probability of the presence of DVT (Wells-Score)

  • Active cancer (1)
  • Paralysis or recent immobilization of the legs (1)
  • Bed rest (>3 days); major surgery (<12 weeks) (1)
  • Pain / hardening along the deep veins (1)
  • Swelling of the whole leg (1)
  • Swelling of lower leg >3 cm opposite opposite side (1)
  • Indentable edema on the symptomatic leg (1)
  • Collateral veins (1)
  • Previous documented DVT (1)
  • Alternative diagnosis at least as likely as deep vein thrombosis (-2)
  • Evaluation of the point score

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Probability of DVT not high (score: <2)

Probability of DVT high (Score: >2)

Literature
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  1. Interdisciplinary S2 guideline(2005): Venous thrombosis and pulmonary embolism. VASA 34: Suppl. 66
  2. Wells PS et al (1998) Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Internal Med 129: 997-1005

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Last updated on: 29.10.2020