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The Wells Score for DVT: Can It Save Your Life?

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Medically reviewed by Laura Kelsey, MD, on October 28, 2024

Deep vein thrombosis (DVT) is a serious condition where blood clots form in the deep veins, usually in the legs. If untreated, a DVT can lead to life-threatening complications such as a pulmonary embolism (PE), where the clot travels to the lungs. Early detection is critical, and one tool that healthcare providers use to assess the likelihood of DVT is the Wells Score. But what exactly is the Wells Score, and why should you be aware of it?

For this article, we spoke to Laura Kelsey, MD, lead vein specialist at Center for Vein Restoration (CVR) vein clinic locations in Grand Rapids, Michigan, and Muskegon (Norton Shores), Michigan. She explained the Wells Score, how it works, and why understanding it is essential for patients and healthcare professionals in determining the likelihood of deep vein thrombosis.

What Is the Wells Score?

The Wells Score is a clinical prediction model designed to estimate the probability of a person having a DVT. It was developed by Dr. Philip Wells in the 1990s to help guide physicians in determining whether further testing, such as an ultrasound or D-dimer blood test, is needed to confirm or rule out a blood clot. The score itself is based on several risk factors and clinical features that are often present in patients with DVT.

“The Wells Score asks a series of questions, and based on the answers, it counts up points. Then, depending on the number of points, it determines whether the probability of having a clot is low, medium, or high. If the patient has a low probability, a D-dimer test is usually performed, which measures the breakdown product of blood clots. If the D-dimer test is normal, it effectively rules out DVT, potentially saving the patient from undergoing an unnecessary ultrasound.” –Dr. Laura Kelsey

In cases where the probability is high, physicians may skip the D-dimer test and proceed directly to an ultrasound, which is the gold standard for diagnosing DVT.

Center for Vein Restoration offers a DVT rule-out service that provides high-priority, non-invasive DVT testing as an alternative to hospital ERs. If you suspect that you or a loved one has a DVT, call the DVT hotline at 877-SCAN-DVT.

Wells Criteria for DVT is a Reliable Clinical Tool

According to a study published by the National Library of Medicine (NIH), the Wells criteria is a reliable tool used to assess the risk of deep vein thrombosis (DVT) in trauma patients. The study evaluated its effectiveness in a trauma population and found a strong correlation between higher Wells scores and increased risk of DVT. Patients with a score of less than one were reliably ruled out for DVT, reducing the need for unnecessary diagnostic procedures. The study highlights the Wells score as a valuable pretest risk stratification tool, guiding clinicians in the effective and cost-efficient diagnosis of DVT in trauma patients.

How the Wells Score Is Calculated

The Wells Score is based on a series of clinical factors. Each factor is assigned a certain number of points, and the total score helps estimate the likelihood of a DVT. Some of the factors included in the Wells Score are:

  1. Active cancer (treatment ongoing or within the last six months) (+1 point)
  2. Paralysis, paresis, or recent immobilization of the lower extremities (+1 point)
  3. Recently bedridden for more than three days or major surgery within the last 12 weeks (+1 point)
  4. Localized tenderness along the distribution of the deep veins (+1 point)
  5. Swelling of the entire leg (+1 point)
  6. Calf swelling by more than 3 cm compared to the asymptomatic leg (+1 point)
  7. Pitting edema confined to the symptomatic leg (+1 point)
  8. Previous history of DVT (+1 point)
  9. Alternative diagnosis at least as likely as DVT (-2 points)

Once the total score is calculated, it falls into one of three categories:

  • 0 or less: Low probability of DVT
  • 1-2: Moderate probability of DVT
  • 3 or more: High probability of DVT

Based on this score, further testing is recommended. For low-probability patients, a D-dimer test is typically performed to rule out DVT. No further testing may be needed if the D-dimer test comes back negative. However, in high-probability cases, an ultrasound is usually performed immediately.

Why the Wells Score Is Important

The Wells Score is significant because it helps physicians make informed decisions about testing for DVT. Instead of sending every patient for an ultrasound—a costly and time-consuming test—physicians can use the Wells Score to assess whether additional tests are necessary.

“The Wells model is still endorsed by the American Society of Family Physicians and Emergency Room Physicians, especially for patients with their first suspected DVT. However, we find that despite its endorsement, many patients don’t have those questions answered, and many times, physicians default right to the ultrasound.” –Dr. Laura Kelsey

This lack of widespread use is unfortunate because the Wells Score can improve patient care by reducing unnecessary testing and the associated costs. It also helps identify high-risk patients and ensures they receive timely diagnosis and treatment, reducing the likelihood of complications like pulmonary embolism.

When Is the Wells Score Used?

The Wells Score is primarily used in settings where a patient presents with symptoms suggestive of DVT, such as leg pain, swelling, or redness. This typically occurs in emergency rooms, primary care offices, or urgent care clinics. However, the Wells Score is not usually used at a specialized vein center like CVR because the patient has already been referred for an ultrasound by their primary care provider or another specialist.

“When patients come to us for a DVT rule-out service, it’s because a provider has already determined they need an ultrasound based on their assessment. What would be interesting is to see how many of those providers actually follow the Wells model before sending the patient for an ultrasound. It’s the most validated model, but it’s just not being used in clinical practice as often as it should be.”Dr. Laura Kelsey

Remember that blood clots can be life-threatening, and early intervention is essential. That’s why Center for Vein Restoration (CVR) offers a same-day DVT rule-out service. Our hotline is 877-SCAN-DVT (877-722-6388).

Why You Should Be Aware of the Wells Score

If you’ve ever had leg swelling, pain, or other symptoms of a potential DVT, understanding the Wells Score can help you feel more informed about your healthcare options. While healthcare professionals are responsible for calculating the Wells Score and deciding on appropriate tests, knowing what the score is and how it works allows you to be an active participant in your care.

Additionally, the Wells Score reminds us that not all testing is necessary, especially in low-risk cases. By being aware of the model, you can ask your physician about their decision-making process and whether a D-dimer test or an ultrasound is the best next step for your situation.

Wells Score for DVT, The Bottom Line

The Wells Score remains one of the most validated and valuable tools for assessing the risk of DVT in patients presenting with symptoms. It offers a structured approach to determining whether further testing is necessary, helping to avoid unnecessary procedures while ensuring that high-risk patients receive prompt diagnosis and treatment.

However, as Dr. Kelsey points out, the Wells Score is often underutilized in clinical practice despite being endorsed by leading medical societies. By raising awareness of the score among both patients and healthcare providers, we can ensure that this valuable tool is used more consistently, improving the accuracy of DVT diagnosis and, ultimately, patient outcomes.

Deep vein thrombosis can result in a life-threatening medical emergency. Center for Vein Restoration (CVR) provides a DVT rule-out service for patients experiencing DVT symptoms. Our comprehensive service includes a DVT scan, treatment, education, and follow-up care. Reach out to the DVT hotline at 877-SCAN-DVT (844-568-3691).


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