Wells Score for Inpatient Deep Vein Thrombosis | Journal Scan
What is the utility of the Wells score for risk stratification of inpatients with suspected deep venous thrombosis (DVT)?
This was a prospective study of 1,135 inpatients suspected of having a DVT at an academic hospital, who were assessed using the Wells score. All of these adult inpatients underwent lower-extremity venous duplex studies between November 1, 2012 and December 31, 2013. Patients with a prior DVT in the prior 3 months were excluded. The main outcome was the Wells score’s utility for risk stratification among inpatients with a suspected DVT based on the risk category (low, moderate, and high).
Of the 1,135 inpatients with suspected DVT, 137 (12.1%) had a proximal DVT. The incidence of proximal DVT increased in low (8/135, 5.9%), moderate (48/506, 9.5%), and high (81/494, 16.4%) risk patient groups (p < 0.001). The area under the curve for the discriminatory accuracy of the Wells score for inpatient DVT was 0.60. The failure rate to classify patients with a low pretest probability was 5.9% (95% confidence interval [CI], 3.0%-11.3%), and the efficiency was 11.9% (95% CI, 10.1%-13.9%).
The authors concluded that the Wells score performed only slightly better than chance for discrimination of DVT risk in hospitalized patients. The authors concluded that the Wells score risk stratification is not sufficient to rule out DVT or influence management decisions in the inpatient setting.
This is the largest study to date evaluating the use of the Wells score for inpatients with suspected DVT. While other smaller studies have suggested that the Wells score is not sufficient for risk stratification of inpatients, this study provides confirmation in a larger population with modern duplex ultrasound utilization. It should be noted that this study did not include the use of a D-dimer test, which has become a routine complementary test for low probability DVT patients in the outpatient setting. It is reasonable to suspect that the combination of a low probability Wells score and a negative D-dimer test result would result in a lower failure rate. However, this combination needs further investigation.
Keywords: Area Under Curve, Fibrin Fibrinogen Degradation Products, Incidence, Inpatients, Outpatients, Probability, Prospective Studies, Risk, Secondary Prevention, Ultrasonography, Doppler, Duplex, Venous Thrombosis
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