DVT Workup
Wells DVT Score → D-Dimer → Compression Ultrasound
This pathway applies the Wells DVT Score to stratify pre-test probability of lower extremity DVT, then guides D-dimer interpretation and imaging decisions. Low-probability patients (Wells ≤ 0) with a negative D-dimer can safely have DVT excluded without ultrasound. High-probability patients (Wells ≥ 3) should proceed directly to compression ultrasound regardless of D-dimer, as a negative D-dimer is insufficiently specific in this group. This approach follows American College of Chest Physicians (ACCP) and European Society of Cardiology guidelines.
Pathway Steps
Wells DVT Score
Check each criterion present — note: alternative diagnosis subtracts 2 points
Age-Adjusted D-Dimer
Determine if D-dimer rules out DVT — threshold adjusts for age > 50
Clinical Disclaimer
This pathway is for educational purposes only. DVT diagnosis requires clinical integration beyond the Wells Score. Bilateral DVT, pelvic DVT, and upper extremity DVT require different evaluation algorithms. Patients with prior ipsilateral DVT may have chronic findings on ultrasound requiring comparison with prior studies.