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Wells Score for Deep Vein Thrombosis

The modified Wells DVT score (−2 to 9) estimates pretest probability of lower-limb deep vein thrombosis: ≥2 "DVT likely" (ultrasound), <2 "DVT unlikely" (D-dimer first; if negative, DVT excluded).

Active cancer (treatment within 6 months or palliative) (yes/no, +1)
Paralysis, paresis or recent plaster cast of the leg (yes/no, +1)
Bedridden ≥ 3 days or major surgery within 12 weeks (yes/no, +1)
Localized tenderness along the deep venous system (yes/no, +1)
Entire leg swollen (yes/no, +1)
Calf swelling ≥ 3 cm vs other leg (yes/no, +1)
Pitting edema confined to the symptomatic leg (yes/no, +1)
Collateral (non-varicose) superficial veins (yes/no, +1)
Previously documented DVT (yes/no, +1)
Alternative diagnosis at least as likely as DVT (yes/no, -2)

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Interpretation

Result	Meaning
< 2	DVT unlikely: D-dimer
≥ 2	DVT likely: ultrasound
≤ 0 / 1–2 / ≥ 3	Three-tier: low / moderate / high

Formula

One point each: active cancer · paralysis/paresis/cast · bedridden ≥ 3 d or surgery < 12 wk · deep-vein tenderness · entire leg swollen · calf swelling ≥ 3 cm · pitting edema (symptomatic leg) · collateral superficial veins · previous DVT. Minus 2 if an alternative diagnosis is at least as likely.

Clinical pearls

The two-tier version (with previous DVT) is from Wells 2003; the original three-tier 1997 model did not include previous DVT.
Not validated in pregnancy or for upper-extremity DVT.

Examples

wells dvt entire leg swollen, calf 4 cm bigger, active cancer dvt probability for a post-op patient with calf tenderness and pitting edema wells dvt prior dvt but cellulitis more likely

FAQ

What Wells DVT score is likely?

A score of 2 or more classifies DVT as likely, warranting compression ultrasound; under 2 is unlikely and a negative D-dimer excludes DVT.

Why can the score be negative?

An alternative diagnosis at least as likely as DVT subtracts 2 points.

Evidence

Cardiology · Reviewed 2026-10-14 · Methodology