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.
Performance of Wells Score for Deep Vein Thrombosis in the Inpatient SettingPC Silveira et al. JAMA Intern Med 175 (7), 1112-7. PMID 25985219. - Clinical TrialThe Wells score performed only slightly better than chance for discrimination of risk for DVT in hospitalized patients. It had a higher failure rate and a lower efficienc …
The Wells Rule and D-dimer for the Diagnosis of Isolated Distal Deep Vein ThrombosisM Sartori et al. J Thromb Haemost 10 (11), 2264-9. PMID 22906051.In clinically suspected DVT with negative proximal compression ultrasonography, pretest clinical probability with the Wells rule has a low diagnostic accuracy for isolate …
Comparison of Empirical Estimate of Clinical Pretest Probability With the Wells Score for Diagnosis of Deep Vein ThrombosisB Wang et al. Blood Coagul Fibrinolysis 24 (1), 76-81. PMID 23103729. - Clinical TrialWells score has been validated for estimation of pretest probability in patients with suspected deep vein thrombosis (DVT). In clinical practice, many clinicians prefer t …
Duplex Ultrasound, Clinical Score, Thrombotic Risk, and D-dimer Testing for Evidence Based Diagnosis and Management of Deep Vein Thrombosis and Alternative Diagnoses in the Primary Care Setting and Outpatient WardJJ Michiels et al. Int Angiol 33 (1), 1-19. PMID 24452081. - ReviewDeep vein thrombosis (DVT) has an annual incidence of 0.2% in the urban population. First episodes of calf vein thrombosis (CVT) and proximal DVT are frequently elicited …
Exclusion of Deep Vein Thrombosis Using the Wells Rule in Clinically Important Subgroups: Individual Patient Data Meta-AnalysisGJ Geersing et al. BMJ 348, g1340. PMID 24615063. - ReviewCombined with a negative D-dimer test result (both quantitative and qualitative), deep vein thrombosis can be excluded in patients with an unlikely score on the Wells rul …
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