Well's Score

Question 1

What is the Well’s Score used for?

Answer 1

It is used along with D-dimer to decide risk of DVT and whether an ultrasound is needed to rule out DVT

Question 2

What are the presenting complaint details used as parameters for risk assessment and what points are given?

Answer 2

Swelling: Calf swelling (>3cm compared to other leg) =1 Entire leg swollen = 1, pitting oedema on symptomatic leg = 1
Other: Collateral veins present (non-varicose) = 1
Localised tenderness = 1 - do SOCRATES!

Question 3

What are the past medical history parameters used?

Answer 3

Immobility: Paralysis, paresis, recent plaster immobilisation of lower extremity = 1
Major surgery/Bed-ridden for more than 3 days within 4 weeks= 1
Other: Active cancer (treatment/palliation in 6 months) = 1, Previous documented DVT = 1

Question 4

Despite not being part of the tool, what drug history question could you ask?

Answer 4

Contraceptive pill?

Question 5

Despite not being part of the tool, what social history questions could you ask?

Answer 5

Been on any flights recently?

Immobility?

Question 6

What is a parameter that might decrease your Well’s score

Answer 6

Alternative diagnosis to DVT as likely or more likely (-2)

Question 7

What is the appropriate management for a Well’s score of 0 or less?

Answer 7

Unlikely to be DVT (<5%)
Do D-dimer:
negative = <1% and no further imaging
positive - precede to US:
negative US is sufficient to rule out DVT
positive US - concerning and consider anticoagulation

Question 8

What is appropriate management for a Well’s score of 1-2?

Answer 8

Moderate risk 17%
Do HIGH SENSITIVITY D-DIMER:
negative - sufficient to rule out (<1%)
positive - precede to US:
negative US - sufficient to rule out DVT
positive US - consider anticoagulation

Question 9

What is appropriate management for a Well’s score of 3 or more?

Answer 9

DVT is likely (17-53%)
ALL should get US but D-dimer done to stratify risk
positive D-dimer: positive US should consider anti-coagulation, negative not sufficient and repeat within a week
negative D-dimer: negative US sufficient to rule out, positive means consider anti-coagulation