Wells et al modified their original criteria for evaluating a patient with suspected deep vein thrombosis (DVT). The authors are from the University of Ottawa, Dalhousie University, University of Western Ontario and McMaster University in Canada.
Patient selection: suspected deep vein thrombosis
Differences from original criteria:
(1) addition of a history of previous deep vein thrombosis diagnosis
(2) interpretation as unlikely or likely
If symptoms are bilateral, then the more symptomatic leg is evaluated.
Parameters:
(1) active cancer
(2) paralysis, paresis or recent plaster immobilization of the lower extremities
(3) recently bedridden for >= 3 days OR major surgery within the previous 12 weeks
(4) localized tenderness along the distribution of the deep venous system
(5) entire leg swollen
(6) calf swelling >= 3 cm larger than the asymptomatic leg (measured at 10 cm below the tibial tuberosity)
(7) pitting edema confined to the symptomatic leg
(8) collateral superficial veins (nonvaricose)
(9) previously documented deep vein thrombosis
(10) alternative diagnosis is at least as likely as deep vein thrombosis
|
Parameter
|
Finding
|
Points
|
|
1 through 9
|
absent
|
0
|
|
|
present
|
1 for each
|
|
alterntive diagnosis
|
less likely
|
0
|
|
|
as or more likely
|
-2
|
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: -2
• maximum score: 9
|
Score
|
Deep Vein Thrombosis
|
|
-2 to 1
|
unlikely
|
|
2 to 9
|
likely
|
If the patient is considered unlikely to have a DVT AND if the D-dimer is negative, then no ultrasonography is needed.
If the patient is considered likely to have a DVT OR if the D-dimer test is positive, then ultrasonography is performed.
