Wells' Criteria for DVT - MDCalc 1/21/19, 1'22 PM

Search “QT interval” or “QT” or “EKG” Log in SIGN UP (/SIGNUP)

(/)

Wells' Criteria for DVT About the Creator

Calculates Wells' Score for risk of DVT.

INSTRUCTIONS
Dr. Phil Wells
Note: The Wells' Score is less useful in hospitalized patients. (Silveira PC, 2015
(http://www.ncbi.nlm.nih.gov/pubmed/25985219))

When to Use Pearls/Pitfalls Why Use Also from MDCalc...

Related Calcs

Geneva Score (Revised) (/geneva-

Active cancer
No 0 score-revised-pulmonary-embolism)
Treatment or palliation within 6 months
Wells' Score for PE (/wells-criteria-
Yes +1 pulmonary-embolism)
Michigan Risk Score (/michigan-risk-
Bedridden recently >3 days or major surgery score-picc-related-thrombosis)
No 0
within four weeks
Yes +1 Content Contributors

Benjamin Slovis, MD
Calf swelling >3 cm compared to the other
No 0 (/contributors/#benjamin-slovis)
leg
Measured 10 cm below tibial tuberosity
Yes +1

Collateral (nonvaricose) superficial veins

No 0
present

Yes +1

Entire leg swollen No 0

Yes +1

Localized tenderness along the deep venous

No 0
system

Yes +1

https://www.mdcalc.com/wells-criteria-dvt Page 1 of 4
Wells' Criteria for DVT - MDCalc 1/21/19, 1'22 PM

Pitting edema, confined to symptomatic leg No 0

Yes +1

Paralysis, paresis, or recent plaster

No 0
immobilization of the lower extremity
Yes +1

Previously documented DVT No 0

Yes +1

Alternative diagnosis to DVT as likely or more

No 0
likely
Yes -2

0 points
Low risk group for DVT. “Unlikely” according to Wells’ DVT studies.

Copy Results # Next Steps

! Next Steps ! Evidence " Creator Insights

ADVICE
As with all clinical decision aids, the Wells’ DVT criteria is meant to aid clinical decision
making and not force management.
The Wells’ DVT criteria should only be applied after a detailed history and physical is
performed.
The Wells’ DVT criteria should only be applied to those patients who have been
deemed at risk for DVT. If there is no concern for DVT than there is no need for risk
stratification.

MANAGEMENT
Patients can be divided into “DVT unlikely” and “DVT likely” groups based on Wells score.
An additional moderate risk group can be added based on the sensitivity of the d-dimer
being used.

https://www.mdcalc.com/wells-criteria-dvt Page 2 of 4
Wells' Criteria for DVT - MDCalc 1/21/19, 1'22 PM

A score of 0 or lower is associated with DVT unlikely with a prevalence of DVT of 5%.
These patients should proceed to d-dimer testing:
A negative high or moderate sensitivity d-dimer results in a probability <1 %
and no further imaging is required.
A positive d-dimer should proceed to US testing.
A negative US is sufficient for DVT rule out.
A positive US is concerning for DVT; strongly consider treatment with
anticoagulation.

A score of 1-2 is considered moderate risk with a pretest probability of 17%.*

These patients should proceed to high-sensitivity d-dimer testing (moderate
sensitivity d-dimer is not sufficient).
A negative high-sensitivity d-dimer is sufficient for rule out of DVT in a
moderate risk patient with a probability of <1%.
A positive high sensitivity d-dimer should proceed to US testing.
A negative US is sufficient for ruling out DVT.
A positive US is concerning for DVT, strongly consider treatment with
anticoagulation.

A score of 3 or higher suggests DVT is likely. Pretest probability 17-53%.

All DVT likely patients should receive a diagnostic US.
D-dimer testing should be utilized to help risk-stratify these DVT-likely patients.
In DVT likely patients with negative d-dimer:
A negative US is sufficient for ruling out DVT, consider discharge.
A positive US should be concerning for DVT, strongly consider treatment
with anticoagulation.

In DVT likely patients with a positive d-dimer:

A positive US should be concerning for DVT, strongly consider treatment
with anticoagulation.
A negative US is still concerning for DVT. A repeat US should be performed
within 1 week for re-evaluation.

*Moderate risk group should only undergo d-dimer testing for rule out without
ultrasonography if a high-sensitivity d-dimer is being used.

CRITICAL ACTIONS
No decision rule should trump clinical gestalt. High suspicion for DVT should warrant
imaging regardless of Wells score.
The Wells’ Criteria for DVT is utilized for the workup of DVT. The presence of DVT is
critical to the evaluation of possible PE, and if PE is on the differential, alternative
decision aids such as the Wells PE (https://www.mdcalc.com/wells-criteria-pulmonary-
embolism) or PERC rule (https://www.mdcalc.com/perc-rule-pulmonary-embolism)
should be entertained.

Have feedback about this calculator? (/contact)

https://www.mdcalc.com/wells-criteria-dvt Page 3 of 4
Wells' Criteria for DVT - MDCalc 1/21/19, 1'22 PM

CALCS ABOUT

Most Popular (/#most- Contact Us (/contact)

popular) About (/about-us)
Recently Viewed FAQs (/faq)
(/#recents) Featured Press (/featured-
Favorites (/#favorites) press)
My Specialty (/#my- EBM Guide (/ebm-guide)
specialty) Join Us (/join-us)
All: A->Z (/#all) Physician's Guide
(https://itunes.apple.com/us/app/mdcalc- New! (/#newest) (/physicians-guide)
medical-calculators-clinical- Paging MDCalc
scores/id1001640662?ls=1&mt=8) (http://paging.mdcalc.com)

(https://play.google.com/store/apps/details? TEAM SOCIAL

id=com.mdaware.mdcalc&hl=en)
Scientific Advisory Board Twitter
(/scientific-advisory- (https://twitter.com/MDCalc)
board) Facebook
Editorial Board (/editorial-
(https://www.facebook.com/MDCalc/)
board)
Google+
Contributors
(https://plus.google.com/+Mdcalc)
(/contributors)
MDCalc Fellows (/fellows)
Partners (/partners)
ACG (/acg)
EB Medicine (/ebmedicine)

Calculations must be re-checked and should not be used alone to

guide patient care, nor should they substitute for clinical judgment.
See our full disclaimer (/disclaimer).

MDCalc ©2005-2018 · All Rights Reserved · Terms of Use (/terms)

· Privacy Policy (/privacy-policy)

https://www.mdcalc.com/wells-criteria-dvt Page 4 of 4