How does the Wells score guide further investigation?
Mostly DVT produces no symptoms and is seen with complications like pulmonary embolism. The diagnosis is confirmed by ultrasound of the limbs. WELL's score is an algorithm used to decide what group to place the patient in according to risk of developing the disease (high risk, intermediate or low). Well's score includes points for: active cancer, history of paralysis, immobilization, tenderness along limb, swelling of entire limb, swelling of limbs compared to the other, pitting edema, dilated superficial vessels, previous history of DVT, presence of alternate diagnosis. If the score is zero= low probability, 1-2 intermediate probability and 3 or more = high probability. If patient has high probability, should get an ultrasound done. If low or intermediate, do D-dimers. If D-dimers are high, then get an USG done. D-dimers are the byproducts of fibrin breakdown and are used to diagnose DVT. Treatment involves use of anticoagulants if less than 5 days history. If history is more than 5 days to 6 months, anticoagulants and monitor for expansion. If more than 6 months anticoagulants and prevention of reoccurrence.
