A 62-year-old woman admitted after a hip fracture is bedridden. On day 4 her left calf measures 4 cm larger than the right, is tender along the course of the deep veins, and shows pitting oedema confined to that leg. She has no cancer, no previous DVT, no alternative diagnosis, and no collateral superficial veins visible. Using the modified Wells score for lower limb DVT, what is the correct interpretation?

• A Score 2, DVT possible; measure D-dimer before imaging
• B Score 4, DVT likely; proceed directly to duplex ultrasound ✓
• C Score 5, DVT excluded; no further investigation needed
• D Score 1, DVT unlikely; discharge with advice

Explanation

She scores 1 each for immobilisation, localised tenderness along the deep venous system, calf swelling greater than 3 cm compared with the other leg, and pitting oedema confined to the symptomatic leg: total 4, which places her in the 'DVT likely' category. In a high probability patient, the next step is compression ultrasonography rather than relying on D-dimer. D-dimer is used to exclude disease in patients with a low or intermediate pretest probability, not to gate imaging when the score is high.

Reference: Rutherford's Vascular Surgery and Endovascular Therapy, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.