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)
- 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
- 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/