Well’s Score
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Pretest clinical probability scoring for DVT: the Wells score
In patients with symptoms in both legs, use the more symptomatic leg.
Clinical features
Score
Active cancer (treatment within last 6 months or palliative)
1
Paralysis, paresis, or recent plaster immobilisation of leg
1
Major surgery or recently bedridden for >3 days in last 4 weeks
1
Local tenderness along distribution of deep venous system
1
Entire leg swollen
1
Calf swelling >3cm compared to asymptomatic leg (measured 10cm below the tibial tuberosity)
1
Pitting oedema
1
Collateral superficial veins (non-varicose)
1
Alternative diagnosis as likely or more likely than that of DVT
-2
Score:
  • ≥3 points: High probability-treat as suspected DVT or perform compression US.
  • 1-2 points: Intermediate probability-treat as suspected DVT and perform compression US.
  • ≤0 points: Low probability of DVT-perform D-dimer test. If positive D-dimer then treat as suspected DVT and perform compression US. If negative D-dimer, DVT reliably excluded.
Adapted Well’s score for Pulmonary Embolism
Clinical features
Score
Clinical signs and symptoms of Deep Vein Thrombosis
3.0
PE is most likely diagnosis
3.0
Tachycardia (>100 bpm)
1.5
Immobilisation or surgery in the previous 4 weeks
1.5
Previously diagnosed DVT or PE
1.5
Haemoptysis
1.0
Malignancy (treatment within last 6 months or palliative)
1.0
Score:
  • ≥7 points: High probability
  • 2.0-6.0 points: Intermediate probability
  • 0-1 points: Low probability

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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