Wells Score
The Wells Score , named after the scientist PS Wells , is the name of three point systems ( scoring systems ) with which the probability of a pulmonary embolism or a deep vein thrombosis (DVT) can be described.
Pulmonary Embolism Score
| Symptoms / observations | Points | Simplified version |
|---|---|---|
| Clinical signs or symptoms of deep vein thrombosis | 3 | 1 point |
| There is no other diagnosis more likely than pulmonary embolism. | 3 | 1 point |
| Heart rate over 100 / min | 1.5 | 1 point |
| Immobilization (even for a few days) or surgery in the past four weeks | 1.5 | 1 point |
| Previously confirmed deep vein thrombosis or pulmonary embolism | 1.5 | 1 point |
| Coughing up blood (hemoptysis) | 1 | 1 point |
| Tumor disease (treated in the last 6 months or tumor palliative therapy ) | 1 | 1 point |
Since pulmonary embolism is very dangerous and an exact diagnosis can only be made with considerable effort (e.g. computed tomography , lung scintigraphy , pulmonary angiography ), it is important that the risk can be assessed on an outpatient basis.
If the sum of the points is more than 4, there is a considerable risk of pulmonary embolism; In the simplified version (see table, right column), pulmonary embolism is likely with ≥ 2 points. With the help of the D-Dimer test, which can be created from a blood test, the informative value can be further improved. The points limit varies according to different publications.
A comparable point system for the same purpose is the Geneva Score .
Deep vein thrombosis score
The Wells score for DVT allows an assessment of the clinical probability of DVT. There is a two-level and a three-level form, with the number of levels relating to the division of the probability into two or three groups. In the two-stage score, an additional point is awarded for previous DVT.
| Symptom / observations | Points |
|---|---|
| Active neoplasia | 1 |
| Paralysis, paresis, or immobilization of the suspect limb | 1 |
| Recently bedridden> 3 days and / or major surgery <4 weeks ago |
1 |
| Pain / induration along the deep veins of the leg | 1 |
| Swollen extremity | 1 |
| Lower leg swollen on one side (> 3 cm compared to the opposite side, measurement 10 cm distal to the tibial tuberosity) | 1 |
| Edema with dents | 1 |
| Presence of non-varicose superficial collateral veins | 1 |
| Existence of an alternative diagnosis that is at least as likely as DVT | -2 |
|
Score <1 : low probability of DVT
Score 1-2 : mean probability (30%) of DVT Score ≥3 : high probability (70-80%) of DVT. |
|
| Symptom / observations | Points |
|---|---|
| Active neoplasia | 1 |
| Paralysis, paresis, or immobilization of the suspect limb | 1 |
| Recent bed rest> 3 days and / or major surgery <4 weeks before |
1 |
| Pain / induration along the deep veins of the leg | 1 |
| Swollen extremity | 1 |
| Lower leg swollen on one side (> 3 cm compared to the opposite side, measurement 10 cm distal to the tibial tuberosity) | 1 |
| Edema with dents | 1 |
| Presence of non-varicose superficial collateral veins | 1 |
| Previous documented DVT | 1 |
| Existence of an alternative diagnosis that is at least as likely as DVT | -2 |
|
Score <2 : low probability of DVT
Score ≥2 : high probability of DVT. |
|
Individual evidence
- ↑ a b AWMF online: Guideline - Venous thrombosis and pulmonary embolism: diagnosis and therapy. Retrieved April 4, 2016 .
- ↑ http://www.mdcalc.com/wells-criteria-for-pulmonary-embolism-pe/
- ^ Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, Forgie M, Kovacs G, Ward J, Kovacs MJ. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001 Jul 17; 135 (2): 98-107. PubMed PMID 11453709 .
- ^ Philippe Furger et al .: Turbo Emergency Medicine. Editions D&F, Neuhausen am Rheinfall 2015, ISBN 978-3-905699-33-3 , p. 193.
