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Mnemonics, Simplified Concepts & Thoughts

Well’s criteria for DVT with Mnemonic

Dr. Sulabh Kumar Shrestha, MS Orthopedics, Oct 9, 2020Jun 18, 2022

Last updated on June 18, 2022

Mnemonic: ABCD(CD)E(CDE) – 4P

A: Alternate diagnosis of DVT more likely (-2)

B: Bedridden recently >3 days or Big (major) surgery within 3 months (+1)

C: Cancer – treatment or palliation within 6 months (+1)

D: Deep venous involvement:

Mnemonic – CD

  • Collateral (non-varicose) superficial veins present (+1)
  • Deep venous system tenderness (+1)

E: Edema:

Mnemonic – CDE

  • Calf swelling > 3cm compared to other leg – measured 10 cm below tibial tuberosity (+1)
  • Denting (pitting) edema of involved leg (+1)
  • Entire leg swollen (+1)

4 P:

  • Paralysis, Palsy or Plaster immobilization (+1)
  • Previous documented DVT (+1)
well's criteria dvt

Rule of 3 – Note the 3 sets of 3:
1. Bedridden for >3 days in 1 month
2. Major surgery in last 3 months
3. More than 3 cm calf enlargement

Pregnant and postpartum women should not be assessed with these criteria and should generally have ultrasonography if DVT suspected.

Interpretation and Applicable algorithm:

1. Score 0 or lower (low risk): 5% risk

2. Score 1-2 (intermediate risk): 17% risk

3. Score 3 or higher (high risk): 17-53% risk

Wells score is low or intermediate – check D-dimer

  1. D-dimer is normal – send home
  2. D-dimer is elevated – obtain ultrasound

Wells score is high – obtain ultrasound

  1. Ultrasound is positive – treat
  2. Ultrasound is negative – obtain D-dimer
    • D-dimer is low – send home
    • D-dimer is elevated – repeat ultrasound 1 week

Sensitivity: 77-98%

Specificity: 38-58%

References:

Wells PS, Anderson DR, Bormanis J, et al. Value of assessment of pretrest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350:1795-1798.

Diagnosis of DVT with D-dimer testing and the Wells score (acutecaretesting.org)

Wells’ Criteria for DVT – MDCalc

dr. sulabh kumar shrestha
Dr. Sulabh Kumar Shrestha, MS Orthopedics

He is the section editor of Orthopedics in Epomedicine. He searches for and share simpler ways to make complicated medical topics simple. He also loves writing poetry, listening and playing music.

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PGMEE, MRCS, USMLE, MBBS, MD/MS Cardiovascular systemGeneral SurgeryInternal medicineOrthopedics

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Shrestha SK. Well’s criteria for DVT with Mnemonic [Internet]. Epomedicine; 2020 Oct 9 [cited 2025 May 29]. Available from: https://epomedicine.com/medical-students/wells-criteria-dvt-mnemonic/.

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