Thromboembolism diagnostic criteria

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Diagnostic Criteria[edit | edit source]

Diagnostic modalities may differ for deep venous thrombosis and pulmonary embolism. Some patients may have the both clinical situations.

Probability Scoring[edit | edit source]

In 2006, Scarvelis and Wells overviewed a set of clinical prediction rules for DVT,^[1] on the heels of a widely adopted set of clinical criteria for pulmonary embolism.^{[2] [3]}

Wells Score or Criteria[edit | edit source]

(Possible score -2 to 9)

1) Active cancer (treatment within last 6 months or palliative) -- 1 point

2) Calf swelling >3 cm compared to other calf (measured 10 cm below tibial tuberosity) -- 1 point

3) Collateral superficial veins (non-varicose) -- 1 point

4) Pitting edema (confined to symptomatic leg) -- 1 point

5) Swelling of entire leg - 1 point

6) Localized pain along distribution of deep venous system -- 1 point

7) Paralysis, paresis, or recent cast immobilization of lower extremities -- 1 point

8) Recently bedridden > 3 days, or major surgery requiring regional or general anesthetic in past 12 weeks -- 1 point

9) Previously documented DVT -- 1 point

10) Alternative diagnosis at least as likely -- Subtract 2 points

Interpretation[edit | edit source]

Traditional interpretation ^{[3] [4]}

• Score >6.0 - High (probability 59% based on pooled data ^[5])
• Score 2.0 to 6.0 - Moderate (probability 29% based on pooled data^[5])
• Score <2.0 - Low (probability 15% based on pooled data^[5])

Alternate Interpretation[edit | edit source]

• Score > 4 - PE likely. Consider diagnostic imaging.^{[3] [6]}
• Score 4 or less - PE unlikely. Consider D-dimer to rule out PE.

References[edit | edit source]

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