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Wells criteria for deep vein thrombosis — pre-test clinical probability of DVT to guide D-dimer testing and compression ultrasound.
Clinical decision-support tool for qualified healthcare professionals. Results are not a diagnosis and should not replace professional clinical judgment.
Two-tier interpretation (most commonly used): ≤1 point = DVT unlikely; ≥2 points = DVT likely. In DVT-unlikely patients a negative high-sensitivity D-dimer safely excludes DVT. Three-tier interpretation: ≤0 low, 1–2 moderate, ≥3 high probability.
Specialty
Emergency MedicineCategory
EmergencyDifficulty
Basic
Estimated Time
30 seconds
Version
1.0
Last Updated
2026-08-15
Formula
Keywords
Normal Range
−2 to 9 points
Estimates the pre-test probability of deep vein thrombosis to guide D-dimer testing and compression ultrasound.
The Wells DVT score adds 1 point for each of nine clinical features (active cancer, paralysis/paresis, bedridden or recent surgery, deep-vein tenderness, entire-leg swelling, calf swelling over 3 cm, pitting edema, collateral superficial veins, and previous DVT) and subtracts 2 points if an alternative diagnosis is at least as likely. A score of 2 or more is DVT likely (two-tier).
Active cancer treated within 6 months or palliative; Yes adds 1 point.
Recent paralysis, paresis, or leg immobilization; Yes adds 1 point.
Recent bed rest or major surgery; Yes adds 1 point.
Tenderness along the deep venous system; Yes adds 1 point.
Swelling of the entire leg; Yes adds 1 point.
Calf swelling exceeding the other leg by more than 3 cm; Yes adds 1 point.
Pitting edema in the symptomatic leg; Yes adds 1 point.
Non-varicose collateral superficial veins; Yes adds 1 point.
Prior documented DVT; Yes adds 1 point.
An alternative diagnosis at least as likely as DVT; Yes subtracts 2 points.
Two-tier: score ≤1 = DVT unlikely (negative high-sensitivity D-dimer safely excludes DVT); score ≥2 = DVT likely (proceed to compression ultrasound). Three-tier: ≤0 low, 1–2 moderate, ≥3 high probability.
Wells DVT criteria allow clinicians to stratify pre-test probability, safely using D-dimer to avoid unnecessary ultrasound while not missing clinically significant thrombosis.
A 55-year-old man is 2 weeks post hip surgery with a swollen, tender left leg, entire-leg swelling, calf swelling, and pitting edema. No alternative diagnosis is as likely as DVT.
Inputs:
Expected Result: Wells DVT score 5 — DVT likely. Proceed directly to compression ultrasound; D-dimer is not recommended.
The two-tier version, which is most commonly used, treats a score of 1 or less as DVT unlikely and 2 or more as DVT likely. The three-tier version instead classifies 0 or less as low, 1 to 2 as moderate, and 3 or more as high probability. Both use the same nine items plus a subtraction of 2 points when an alternative diagnosis is at least as likely. Choose one system and apply it consistently, because a negative D-dimer safely excludes DVT only in the DVT-unlikely group.
It is the only negative item. When an alternative diagnosis is judged at least as likely as DVT, the score subtracts 2 points from the total of the nine positive items. Because this judgment is subjective, it can move a patient across the two-tier cutoff, so it should be applied deliberately. Without this subtraction the score can be overestimated and a patient who could safely have D-dimer testing may instead be sent for compression ultrasound.
No. A score of 1 or less means DVT is unlikely, which makes the patient suitable for a high-sensitivity D-dimer. Only a negative D-dimer in that group safely excludes DVT. When clinical suspicion remains high, a low score does not exclude DVT and imaging should still be considered. The score estimates pre-test probability; it is not a stand-alone diagnostic test.
Disclaimer: This calculator is intended for educational and clinical decision support purposes only. The Wells DVT score guides, but does not replace, compression ultrasound and clinical judgment.