Well’s criteria for DVT with Mnemonic

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


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