Applicability of wells' criteria for diagnosis of deep vein thrombosis in lower extremities at Dhulikhel hospital, Kathmandu university hospital

Introduction: Deep vein thrombosis (DVT) is the presence of thrombus in deep venous system, commonly encountered in lower extremities. P. S. Wells was one of the pioneers to diagnose DVT without relying on imaging methods and using the clinical criteria for patient management. Methods: All the patients with clinical suspicion of DVT in lower extremities (new onset edema, pain) visiting the Outpatient Department or Emergency Department of Dhulikhel Hospital between September 2012 and August 2016 were included in the study. The patients were asked/examined for knowing all the points in Wells' criteria. Confirmation of the diagnosis was done by color Doppler ultrasonography on the same day by a radiologist. The patients were categorized into three groups as ≥3 as high probability, 1–2 as moderate probability, and <0 as low probability. Results: There were 68 patients with a history suggestive of DVT. Doppler ultrasonography being considered as gold standard for diagnosis confirmed 65 cases as DVT (95.6%) on the 1st day and remaining 3 cases were confirmed on the 3rd day in repeat Doppler ultrasonography. Mean age was 55.5 years (range: 34–75, standard deviation [SD] 11.3 years). Mean days of history was 3 days (range 1–10 days, SD 2.2 days). Pitting edema was present in 95.6% of cases which was the most common clinical characteristic in patients with DVT. This was followed by swelling of entire leg (67.6%), followed by localized tenderness along the distribution of deep venous system (64.7%). In 51 cases (75%), Wells' score was ≥3 (high probability), while in 14 cases (20.6), it was 1–2 (moderate probability) and in 3 cases (4.4%) it was