Template:Modified Wells Score: Difference between revisions

Latest revision as of 00:04, 27 November 2018

Modified Wells Score

Can be applied for patients whose clinical presentation is concerning for a DVT in order to risk stratify.

Active cancer (<6 mo) (1pt)
Paralysis, paresis, or immobility of extremity (1pt)
Bedridden >3 days because of symptoms within 4 weeks (1pt)
TTP along deep venous system (1pt)
Entire leg swollen (1pt)
Unilateral calf swelling >3cm below tibial tuberosity (1pt)
Unilateral pitting edema (1pt)
Collateral superficial veins, not varicose (1pt)
Previously documented DVT (1pt)
Alternative diagnosis as likely or more likely than DVT (-2pts)

Scoring:

A score of 0 or lower → minimal risk - DVT prevalence of 5%. D-dimer testing is safe in this group - negative d-dimer decreases the probability of disease to <1% allowing an ultrasound to be deferred.
A score of 1-2 → moderate risk - DVT prevalence of 17%. D-dimer testing still effective and a negative test decreases post-test probability disease to <1%
A score of 3 or higher → high risk - DVT prevalence of 17-53% → patients should receive an ultrasound^[1]

↑ Del Rios M et al. Focus on: Emergency Ultrasound For Deep Vein Thrombosis. ACEP News. March 2009. https://www.acep.org/clinical---practice-management/focus-on--emergency-ultrasound-for-deep-vein-thrombosis/

[1] Del Rios M et al. Focus on: Emergency Ultrasound For Deep Vein Thrombosis. ACEP News. March 2009. https://www.acep.org/clinical---practice-management/focus-on--emergency-ultrasound-for-deep-vein-thrombosis/

[1]

@@ Line 1: / Line 1: @@
-''Can be applied for patients who's clinical presentation is concerning for a DVT in order to risk stratify.''
+===[[Modified Wells Score]]===
-*Active cancer (<6 mo) - 1pt
+''Can be applied for patients whose clinical presentation is concerning for a [[DVT]] in order to risk stratify.''
-*Paralysis, paresis, or immob of extremity - 1pt
+*Active cancer (<6 mo) (1pt)
-*Bedridden >3 d b/c of symptoms (within 4 wk) - 1pt
+*Paralysis, paresis, or immobility of extremity (1pt)
-*TTP along deep venous system - 1pt
+*Bedridden >3 days because of symptoms within 4 weeks (1pt)
-*Entire leg swollen - 1pt
+*TTP along deep venous system (1pt)
-*Unilateral calf swelling >3cm below tibial tuberosity - 1pt
+*Entire leg swollen (1pt)
-*Unilateral pitting edema - 1pt
+*Unilateral calf swelling >3cm below tibial tuberosity (1pt)
-*Collateral superficial veins (not varicose) - 1pt
+*Unilateral pitting edema (1pt)
-*Previously documented [[DVT]] - 1pt
+*Collateral superficial veins, not varicose (1pt)
-*Alternative diagnosis as likely or more likely than [[DVT]] - (-)2pts
+*Previously documented [[DVT]] (1pt)
+*Alternative diagnosis as likely or more likely than [[DVT]] (-2pts)
-'''[[Modified Wells Score|Scoring]]:  '''
+'''[[Modified Wells Score|Scoring]]:'''
-A '''score of 0 or lower''' is associated with DVT unlikely with a prevalence of DVT of 5%. D-dimer testing is safe in this group and will decrease the probability of disease to <1 % allowing an [[DVT ultrasound|ultrasound]] to be deferred. '''A score of 1-2''' is considered moderate risk (17%) for DVT but can still proceed with testing using a high sensitivity D-dimer to decrease the post test probability of a [[DVT]] to <1% if negative but require [[DVT ultrasound|ultrasound]] if positive.  '''A score of 3 or higher''' suggests DVT is likely (17-53%) and patients should receive an [[DVT ultrasound|ultrasound]] but also send a [[d-dimer]] because if the [[D-dimer]] is positive and the ultrasound is negative, the patient should receive a followup ultrasound in 2 weeks.<ref>Del Rios M et al. Focus on: Emergency Ultrasound For Deep Vein Thrombosis. ACEP News. March 2009. https://www.acep.org/clinical---practice-management/focus-on--emergency-ultrasound-for-deep-vein-thrombosis/.</ref>
+*A '''score of 0 or lower''' → minimal risk - [[DVT]] prevalence of 5%. D-dimer testing is safe in this group - negative d-dimer decreases the probability of disease to <1% allowing an [[DVT ultrasound|ultrasound]] to be deferred.
+*A '''score of 1-2''' → moderate risk - [[DVT]] prevalence of 17%. D-dimer testing still effective and a negative test decreases post-test probability disease to <1%
+*A '''score of 3 or higher''' → high risk - [[DVT]] prevalence of 17-53% → patients should receive an [[DVT ultrasound|ultrasound]]<ref>Del Rios M et al. Focus on: Emergency Ultrasound For Deep Vein Thrombosis. ACEP News. March 2009. https://www.acep.org/clinical---practice-management/focus-on--emergency-ultrasound-for-deep-vein-thrombosis/</ref>