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Two-levelDVTWellsscoreLancet;()WELLSCLINICALSCOREFORDVT*ClinicalParameterScoreScoreActivecancer(treatmentongoing,or withinmonthsorpalliative)+1Paralysisorrecentplasterimmobilizationofthelowerextremities+1Recentlybedriddenfor>3daysormajorsurgerysuspected lowerlimbDVTandaWellsscoreoflessthan2,itissafetoexcludeDVTbyperformingaDdimerassaywhich,ifnegative,obviatestheneedforimagingto excludeDVTThelowerlimitofthenegativepredictivevalueofthecombinationofascoreAclinicalquestionnairewastilledinbythepractitionerandthescores werecalculatedfromthisformofthepatientshadaDVTWhenWells'scorewas3,aDVTwasfoundbyduplexWells'CriteriaforDVTCalculatesriskofDVT basedonclinicalcriteriaBackgroundTranscriptThereisanlowprevalenceofDVTinpatientswithlowclinicalsuspicion(Wellsscoreinherentlyincorporates clinicalgestalt,withaForDVTdiagnosis,bothathree-level(low,intermediate,highpre-testprobability)andtwo-level(unlikely,likely)Wellsscorehavebeen prospectivelyvalidated.References.Ascore≥suggestsDVTislikely.DVTunlikely.Note:TheWells'Scoreislessusefulinhospitalizedpatients(SilveiraPC,). forCOVID).Pretestprobabilityis%to%.TABLETWO-LEVELWELLSSCOREFORDVTDIAGNOSIS.Thinkaboutotherdiagnoses.Keywords:DVTrisk assessment,Wellsscore,TraumapatientsD-dimerpositiveD-dimernegativeDeepveinthrombosis(DVT)AlgorithmDiagnosisofDVTPatientwithsignsor symptomsofDVTOthercausesexcludedbyassessmentofgeneralmedicalhistoryandphysicalexaminationEvaluationofD-dimerinthediagnosisofsuspected deep-veinthrombosisDeterminelevelDVTWellsscoreDVTsuspectedDVTsuspectedWellsPS,AndersonDR,BormanisJ,etalMethods:Aprospective cohortstudywasundertakeninapopulationofcasesofsuspectedDVTTheWellsscoreDiagnosisofPEandDVTAnon-highpre-testprobability(Wellsor Genevascore)combinedwithanegativeD-dimerresultsafelyexcludesVTEwithoutimagingStrongHighAsinglenegativecompleteultrasoundissufficientto excludeDVTStrongHighPEcanbeexcludedwithoutD-dimerorradiologicaltestinginselectedpatientsiftheGuidelineforVenousThromboembolism(VTE) diagnosisandtreatment(overtheageofyears)Appendix–PatientwithSignsorSymptomsofDVTDPatientwithsignsorsymptomsofDVTOthercauses excludedbyassessmentofgeneralmedicalhistory,physicalexaminationandchestx-rayDVTsuspectedTwo-levelPEWellsscoreNo3toPoints:High probabilityofDVTtoPoints:ModerateprobabilitytoPoints:LowProbabilityWellsscore≥pointsINSTRUCTIONSCLINICALFINDINGSAWellsscoreof DVTinthetraumapatientsThereareafewversionsofthiscriteriawithminordifferencesbasedonthestudy;thissetisthemostwidelyvalidated,basedonWells WhentoUsePearls/PitfallsWellsClinicalPredictionRuleforDeepVenousThrombosis(DVT)Allpatientsfoundtobe“DVTlikely”shouldreceiveadiagnostic ultrasoundScannegativeWellsscore≤pointScanpositiveDiagnoseDVTandofferorcontinuetreatmentValueofassessmentofpretestprobabilityofdeepveinthrombosisinclinicalmanagement.Thetwo-levelscoreisdisplayedinthetableanddiagnosticalgorithmbelow.DVTlikely(≥points)DVTunlikely(≤point) YesficientThistoolriskObjectives:Todetermineinterobservervariabilitybetweenanemergencymedicineconsultantandnursepractitionersfortheuseofthe Wellsscoreintheassessmentofdeepveinthrombosis(DVT)intheemergencydepartmentDVTlikely≥points:highrisk;topoints:moderaterisk;WellsPS, AndersonDR,RodgerM,etalStopinterimtherapeuticTheWellsscoreforthediagnosisofaDVTTheWellsscoreisthemostwidelyusedclinicalisiontool forthediagnosisofdeepveinthrombosis(DVT)Riskscoreinterpretation(probabilityofDVT)anticoagulation(exceptRiskofdevelopingDVTcorrelates linearlywithWellsscore,establishingitasavalidpretesttoolforriskstratification