WELLS Score for evaluating a suspected DVT

NOTE: Whilst we have done our utmost to ensure the accuracy of the data in this section, users should access the original publications.

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1. The original 1997 DVT WELLS score used a three-level risk stratification system:
High ≥3 points
Intermediate 1–2 points
Low ≤1 point

The 2003 version used two levels of risk stratification.

In 2003 a previously documented DVT, was added to the WELLS score and the duration of risk after surgery was increased from 4 weeks to 12 weeks.

2. The sensitivity of D-dimer tests varies and a highly sensitive D-dimer assay should be employed.

3. Current NICE guidelines recommend when using a point-of-care or laboratory D-dimer test, to consider the use of an age-adjusted D-dimer test threshold for people aged over 50.

1. Wells PS, Anderson DR, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997; 350: 1795-8.

2. Wells PS, Owen C, et al. Does this patient have deep vein thrombosis? JAMA : the journal of the American Medical Association. 2006; 295: 199-207.

3. NICE Guidance for DVT

Active cancer [ongoing treatment or within the previous 6 months or palliative]
	1 Point
Paralysis, paresis or recent plaster immobilisation of the lower limbs
	1 Point
Recently confined to bed for 3+ days or major surgery within the previous 12 weeks requiring general or regional anaesthesia
	1 Point
Localised tenderness along the distribution of the deep venous system
	1 Point
Entire leg swelling
	1 Point
Calf swelling at least 3cm larger that of the asymptomatic leg [measured 10cm below the tibial tuberosity]
	1 Point
Pitting oedema confined to the symptomatic leg
	1 Point
Collateral superficial veins [non-varicose veins]
	1 Point
Previously documented DVT
	1 Point
Alternative diagnosis at least as likely as DVT
	-2 Points

Interpretation
≤ 1 Point	Low probability for DVT
≥ 2 Points	Intermediate/high probability for DVT

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