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Wells Score for Deep Vein Thrombosis

Wells DVT rule (Wells 1997/2003); two-tier per NICE NG158

Combines nine one-point clinical items with a −2-point alternative-diagnosis item to classify suspected lower-limb DVT as unlikely or likely (NICE two-tier) or low/moderate/high (three-tier).

Also searched as: DVT · pre-test probability · D-dimer · ultrasound · decision rule · clot · leg

Criteria present (check all that apply)

Include the alternative-diagnosis item when another cause is at least as likely; it subtracts 2 points.

Lower concern
Wells DVT 0 — DVT unlikely (low probability)
Score: 0
  • Total score: 0 (range −2 to +9).
  • Two-tier (NICE NG158): DVT unlikely (likely >= 2, unlikely <= 1).
  • Three-tier: low probability (low <= 0, moderate 1-2, high >= 3).
  • No criteria present.
  • DVT unlikely: a negative high-sensitivity D-dimer excludes DVT; a positive D-dimer requires ultrasonography.
Caveats
  • Derived for a first suspected lower-limb DVT; less reliable for recurrence, inpatients, and pregnancy.
  • The surgery window is 12 weeks per NICE NG158 and the 2003 NEJM validation (some older texts say 4 weeks).

How this tool works

Each of nine findings (active cancer, immobilization or paralysis, recent bed rest or major surgery, deep-vein tenderness, whole-leg swelling, calf asymmetry of 3 cm or more, pitting edema, collateral superficial veins, and prior documented DVT) adds one point, while an alternative diagnosis judged at least as likely as DVT subtracts two. Per NICE NG158 and the Wells 2003 validation, a total of 2 or more means DVT likely (proceed to compression ultrasonography) and 1 or less means DVT unlikely (a negative high-sensitivity D-dimer then excludes DVT). The original three-tier reading is low at 0 or below, moderate at 1-2, and high at 3 or more.

References

Implemented from the cited published sources. Educational use only; confirm against current guidelines before clinical use.

Clinical questions that use this

Vetting guides that reach for this tool.

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