Score the 10 Wells items and see when a patient needs same-day medical evaluation.
The Wells Criteria estimates how likely a deep vein thrombosis (DVT) in the leg is, from 10 findings in the history and exam. Physical therapists use it when a patient has new calf pain, swelling or warmth, especially after surgery, a fracture, a cast or time in bed. It takes about 2 minutes once you’ve examined the leg.
Several items need a hands-on exam. If you’re a patient worried about a swollen, painful leg, call your doctor today. Call 911 for sudden shortness of breath, chest pain, coughing up blood or fainting, which can be signs of a blood clot in the lungs.
This supports clinical judgment. It is not a diagnosis. A low score doesn’t rule out DVT without testing, and a high score needs medical work-up. Use it only when DVT is a real concern, after a history and exam.
Sources. Wells PS, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350(9094):1795-1798. Wells PS, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003;349(13):1227-1235. Hillegass E, Lukaszewicz K, Puthoff M. Role of physical therapists in the management of individuals at risk for or diagnosed with venous thromboembolism: evidence-based clinical practice guideline 2022. Phys Ther. 2022;102(8):pzac057 (APTA Academies of Cardiovascular & Pulmonary PT and Acute Care; Action Statement 5, evidence level I, grade A: use the Wells criteria to judge the likelihood of a leg DVT). Holsman Physical Therapy is not affiliated with these authors or journals, and they do not endorse this website.
Next step: If DVT is suspected, the patient needs same-day medical evaluation before therapy continues. Once a clot is ruled out or treated, Holsman physical therapists see patients at clinics across North Jersey, the Bronx and Brooklyn, plus in-home visits. Refer a patient or call 1-855-465-7626.
The Wells Criteria is a clinical prediction rule that estimates how likely a deep vein thrombosis (DVT) in the leg is, using 10 findings from the history and exam. It was developed by Dr. Philip Wells and colleagues (Lancet 1997; updated in NEJM 2003).
Nine findings score 1 point each. If another diagnosis is at least as likely as DVT, subtract 2 points. Scores range from -2 to 9.
In the two-level version (Wells 2003), a score of 2 or more means DVT is likely and under 2 means DVT is unlikely. In the three-level version (Wells 1997), 0 or less is low, 1 to 2 is moderate and 3 or more is high pre-test probability.
The Wells score supports clinical judgment and does not rule DVT in or out by itself. When DVT is suspected, and especially with a score of 2 or more, hold exercise and manual treatment of that leg and send the patient for same-day medical evaluation (D-dimer or duplex ultrasound). Signs of a pulmonary embolism, such as sudden shortness of breath or chest pain, need 911.
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