Study to determine Wells criteria as a reliable clinical tool in diagnosis of deep vein thrombosis: a one year cross-sectional single centric hospital based study
Keywords:Deep vein thrombosis, Venous thrombosis, Pulmonary embolism
Background: Venous thromboembolism which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE) is one of the major cardiovascular causes of death along with myocardial infarction and stroke. DVT is a common problem in non-ambulatory and hospitalized patients. It is a major cause of morbidity and mortality in these patients. Venous thromboembolism mimics other illnesses making its diagnosis difficult. In such circumstances clinical improvement often fails to occur despite standard medical treatment of the concomitant illness.
Methods: A prospective cross-sectional study was conducted at tertiary care hospital in which 40 patients with complaint of limb swelling were included. Risk was calculated according to the wells criteria and confirmed with color Doppler of the affected limb.
Results: Majority of people were more than 50 years with male preponderance and with history of smoking present. Subjects had leg swelling with edema and calf tenderness. Results were well established in favor of Wells criteria for making diagnosis of DVT. This criterion showed 100% sensitivity with a negative predictive value of 100% and an accuracy of 90%.
Conclusions: This criterion can help the clinicians to treat the disease before it takes a violent course and help the patients live a healthy life. The present study was done in a small proportion of patients. It is highly recommended that thorough studies and researches be conducted so that modern medicine can be highly efficacious, with newer techniques and procedures which can be beneficial for the patients.
Kesieme E, Kesieme C, Jebbin N, Irekpita E, Dongo A. Deep vein thrombosis: a clinical review. J Blood Med. 2011;2:59-69.
Engelberger RP, Aujesky D, Calanca L, Staeger P, Hugli O, Mazzolai L. Comparison of the diagnostic performance of the original and modified Wells score in inpatients and outpatients with suspected deep vein thrombosis. Thromb Res. 2011;127(6):535-9.
Modi S, Deisler R, Gozel K, Reicks P, Irwin E, Brunsvold M, et al. Wells criteria for DVT is a reliable clinical tool to assess the risk of deep venous thrombosis in trauma patients. World J Emerg Surg. 2016;11:24.
Freedman J, Loscalzo J. Arterial and venous thrombosis. In: Longo DL, Kasper DL, Jameson LJ, Fauci A, Hauser S, Loscalzo J eds. Harrison’s Principles of Internal Medicine. New York: McGraw Hill; 2015: 740-5.
White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(1):4-8.
Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ . Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population based study. Arch Intern Med. 1998;158(6):585-93.
Scarvelis D, Wells PS. Diagnosis and treatment of deep-vein thrombosis. CMAJ. 2006;175(9):1087-92.
Pengo V, Lensing AW, Prins MH, Marchiori A, Davidson BL, Tiozzo F, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004;350(220:2257-64.
Kahn SR, Ginsberg JS. Relationship between deep venous thrombosis and the post thrombotic syndrome. Arch Intern Med. 2004;164(1):17-26.
Anderson FA, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107:9-16.
Naqvi SE, Haseen MA, Beg MH, Ali E, Khan T. Deep vein thrombosis: an experience of 25 years from North India. Indian J Vasc Endovasc Surg. 2016;3:2-6.
Dewar C, Corretge M. Interrater reliability of the Wells score as part of the assessment of DVT in the emergency department: agreement between consultant and nurse practitioner. Emer Med J. 2008;25(7):407-10.
Wells PS, Anderson DR, Bormanis J. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350(9094):1795-8.
Kahn SR. The clinical diagnosis of deep venous thrombosis: integrating incidence, risk factors, and symptoms and signs. Arch Intern Med. 1998;158(21):2315-23
Oudega R, Hoes AW, Moons KG. The Wells rule does not adequately rule out deep venous thrombosis in primary care patients. Ann Intern Med. 2005;143(2):100-7.