Well's Criteria for DVT/PE

When we are clinically suspecting a deep vein thrombosis or pulmonary embolism we need to use a composite of clinical findings to estimate our pre-test probability of having the event - this is because no single finding is sensitive enough on it's own. As thromboembolic disease can have catestophic results, we want to ensure that the sensitivity of our composite of tests is high. The name "Wells" appears frequently...

Deep Vein Thrombosis: Wells Scoring System
[JAMA 1998; 279: 1094 – 1099]

• Active Cancer (on treatment/within 6 months/palliative): 1
• Paralysis, paresis, or recent plaster immobilization of the lower extremities: 1
• Recently bedridden for >3 days or major surgery within 4 weeks: 1
• Localized tenderness along the distribution of the deep venous system: 1
• Entire leg swelling: 1
• Calf swelling > 3 cm compared to asymptomatic leg (measured 10 cm below tibial tuberosity): 1
• Pitting edema (greater in the symptomatic leg): 1
• Collateral superficial veins (nonvaricose): 1
• Alternative diagnosis as more likely than that of deep vein thrombosis: -2

DVT Clinical Pretest Probability
Is the score...

A. Greater than/equal to 2? DVT Likely
B. Less than 2? DVT unlikely

Pulmonary Embolism: Modified Wells’ criteria
[Ann Intern Med 2001; 135: 98 – 107]

• Clinical findings suggestive of DVT: 3
• No other more likely alternative diagnosis: 3
• Immobilization (bedridden ³ 3 days) or major surgery within past 4 wks: 1.5
• HR > 100: 1.5
• Previous DVT/PE: 1.5
• Active malignancy: 1
• Hemoptysis: 1
  

Simplified Wells Criteria Scoring System [JAMA 2006; 295: 172-179]
Is the score...

A. Greater than 4? PE Likely
B. Less than 4? PE Unlikely

Your choice of investigations will be determined from the above scoring systems - whether thromboembolic disease is "likely" or "unlikely". More on this soon.

It is also important to ask yourself why this person his having thromboembolic disease in the first place?

(Get it? Get it? There's a picture of a well. Well's criteria? Yeah - that's terrible, I know.)