Wells criteria for DVT is a reliable clinical tool to assess the risk of deep venous thrombosis in trauma patients

Abstract

BackgroundDeep 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.MethodsWells 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.ResultsOf 298 patients evaluated, 18 (6 %) patients were positive for DVT. A linear correlation was present between Wells score and DVT with R2 = 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.ConclusionsA 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13017-016-0078-1) contains supplementary material, which is available to authorized users.

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“…We developed the Himi score for risk assessment for the onset of DVT by using factors that multivariate analysis showed to be significantly related to DVT, and compared the accuracy of this score with those of the Wells and Padua scores. Consistent with the score ranges reported in previous studies (Wells: 0.9–2.38; Padua: 2–4.56), the average Wells and Padua scores were 1.39 and 3.21, respectively . However, the AUC of the Himi score was significantly higher than those of Wells and Padua scores.…”

Modelling idiopathic Parkinson disease as a complex illness can inform incidence rate in healthy adults: the PREDIGT score

“…Risk stratification for decision‐making has evolved into important tools for medical practitioners in both clinical and research settings, where they are applied to the prevention of illness, avoidance of complications, and slowing of disease progression. This has led to the development of validated and well‐established scoring systems, such as those employed in the risk assessment for annual embolic stroke from atrial fibrillation (Hsu et al ., ), of coronary events associated with dyslipidaemia (Preiss & Kristensen, ), and of deep vein thrombosis and its complications, such as pulmonary emboli (Modi et al ., ).…”

Investigating Effect of Nursing Interventions, Based on Wells Score Results, on the Incidence of Deep Vein Thrombosis in Patients Admitted to the Intensive Care Unit

“…The results also showed that 2 patients in the control group who were detected as being at risk were diagnosed with DVT using Wells score, while none of the subjects in intervention group experienced DVT. Similarly, Modi et al showed a linear relationship between the Wells score and the incidence of DVT in such way that there is no risk of developing DVT if the patient is in a low-risk group based on the Wells scoring instrument (<1), and there is likelihood of DVT if (s)he is placed in the medium-or high-risk groups [26]. Dybowska et al's study also showed that the use of Wells score in primary care shows a high degree of accuracy [27].…”