Deep Venous Thrombosis(DVT) occurs in approximately 1-2 per 1000 of the population. Our great concern is not the DVT as such, but the potential for other sequelae, especially a pulmonary embolism. What I see and what I’m also guilty of, on several occasions is that these patients are simply sent to ultrasound and we don’t apply the well known Well’s Score(JAMA, 2006;295(2):199-207).
I was asked recently, “Do you use D-dimer to rule out your DVT’s?” I searched my brain and remember saying, ‘If they are a low pre-test probability I may just send them off”, but I knew that I had not calculated a Well’s Score in a long time……..so time to review.
The area that causes the greatest concern is the last item on the list; ‘Alternative diagnosis to DVT at least as likely’. This is your interpretation, your gestalt. It is your experience and gut feeling about the potential of another cause, based on the history and examination. For example, your thinking would be changed if someone came in with simple calf pain, but you found out that there had been direct muscle trauma. It appears that specialists do this better.
I’m not sure about you, but I don’t need yet another score to remember. I’m going back to Wells and getting my gestalt going again.