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Wells Criteria for DVT Is a Reliable Clinical Tool to Assess the Risk of Deep Venous Thrombosis in Trauma Patients


Wells Criteria for DVT Is a Reliable Clinical Tool to Assess the Risk of Deep Venous Thrombosis in Trauma Patients

Shrey Modi et al. World J Emerg Surg.


Background: Deep Vein Thrombosis (DVT) is a common complication in trauma patients. Venous duplex surveillance is used widely for the diagnosis of DVT, however, there is controversy concerning its appropriate use. The Wells criterion is a clinically validated scoring system in an outpatient setting, but its use in trauma patients has not been studied. This study evaluated the application of the Wells scoring system in trauma population.

Methods: Wells scores were calculated retrospectively for all patients who were admitted to the trauma service and underwent Venous Duplex Scanning (VDS) at the author's institution between 2012 and 2013. Correlation of Wells score with DVT and its efficacy in risk stratifying the patients after trauma was analyzed using linear correlation and receiver operating characteristic (ROC) curve. Sensitivity and specificity of Wells score in ruling out or ruling in DVT were calculated in various risk groups.

Results: Of 298 patients evaluated, 18 (6 %) patients were positive for DVT. A linear correlation was present between Wells score and DVT with R (2) = 0.88 (p = 0.0016). Median Wells score of patients without DVT was 1 (1-3) compared to a median score of 2 (1-5) in those with DVT (p < 0.0001). In low risk patients (scores <1), Wells scoring was able to rule out the possibility of DVT with a sensitivity of 100 % and NPV of 100 %, while in moderate-high risk patients (scores ≥2), it was able to predict DVT with a specificity of 90 %. Area under ROC curve was 0.859 (p < 0.0001) demonstrating the accuracy of Wells scoring system for DVT risk stratification in post trauma patients.

Conclusions: A Wells score of <1 can reliably rule out the possibility of DVT in the trauma patients. Risk of developing DVT correlates linearly with Wells score, establishing it as a valid pretest tool for risk stratification.

Keywords: DVT risk assessment; Trauma patients; Wells score.


Fig. 1
Fig. 1
Incidence of DVT by probability estimation on the Wells scoring system: low, moderate, and high. Incidence increases with increasing risk. a Distribution of Wells scores in patients with and without DVT on Venous duplex surveillance (VDS). b Median Wells score of patients with DVT was significantly higher than the median Wells score of patients without DVT (2 vs. 1, p <0.0001)
Fig. 2
Fig. 2
Correlation between Wells score and incidence of DVT with coefficient of determination (R 2 = 0.88, p = 0.0016) demonstrating a strong linear correlation. a Receiver operating characteristic (ROC) curve demonstrating the performance of Wells score in predicting likelihood of DVT. b Area under the ROC curve (AUROCC) value shows that high Wells scoring system is efficient in identifying the patients at risk for developing DVT based on their estimated probability after trauma
Fig. 3
Fig. 3
Flowchart of the protocol demonstrating potential use of Wells criteria for DVT surveillance and risk stratification in trauma patients

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