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Wells Score Rules: to Predict Cardiovascular Diseases

Created in order to help doctors identify the likelihood of either deep vein thrombosis (DVT) or pulmonary embolism (PE) is the Wells Score. Although there have been several different models implemented in different hospitals and clinics, all have the same intent on honing in on either of these diseases. The Wells Score is known as a clinical prediction rule, or a medical study where researchers create a list that includes the most probably symptoms or causes or a specific disease. The Wells Score is regarded as the only approved model used to determine the chances of either of these diseases. If you do show many of the symptoms included in the Wells Score, be sure to look at some VTE treatments.

+ Yet, despite its benefits to doctors, nurses, and their patients, there are two concerning aspects of this specific clinical prediction rules that is important to address. The majority of these prediction tools are undercut by the fact that there is almost always an overestimation when it comes to the risks of diseases, in this case DVT and PE. Many believe that this could be because of cognitive factors like base rate fallacy, which essentially places too much confidence in the larger percentage of an outcome to a fault. Another concerning point to address is that, someone with DVT or PE may never even have the opportunity to take the Wells Score due to the fact that they may show no signs of contracting either disease.

The Model

Although the Wells Score has its faults, whether with the model itself or that it cannot account for those with no symptoms, it still is a very useful tool when trying to identify DVT or PE early. The model has been made up in several different ways, one of them being:

• Clinical signs and symptoms of DVT (+3)
• PE is #1 diagnosis OR equally likely (+ 3)
• Heart rate > 100 (+1.5)
• Immobilization at least 3 days OR surgery in the previous 4 weeks (+1.5)
• Previous, objectively diagnosed PE or DVT (+1.5)
• Hemoptysis (+1)
• Malignancy w/ treatment within 6 months or palliative (+1)

The numbers to the right of the Wells Score criteria are the values that determine the possibility of having either DVT or PE. Regardless of the model these questions are score anywhere from -2 to 3 points. In most cases, the likelihood is split into a three tier model.

• Tier 1: A score less than two indicates that the patient is at low risk
• Tier 2: A score between 2-6 indicates that the patient is at a moderate risk
• Tier 3: A score greater than 6 means that the patient is at high risk

Other Factors

There are a couple factors to be cognizant of when administering a Wells Score test to either yourself or a patient. First, it is important to apply the Wells Score test to patients after extensively reviewing their medical history as well as performing a medical physical. Also, once the review and physical are completed it is vital to only apply the test to those who are at risk for DVT or PE.

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