Well, well, well…they prepare us for a lot in DPT school, I think we all have had nightmares of those “RED FLAGS.” Often it feels like a terrific overload and that even though they are preparing us for the ‘worst’ … likely it won’t be something we actually see in clinic.
However, last Friday I went in to get one of my patients out of bed and he started to complain of some leg pain. So…here I am all alone, looking at an edematous (*swollen), red, painful leg and thinking to myself –> No. Flipping. Way. Then out of no where my mind clicks on and I was actually able to run through the Well’s Clinical Prediction Rule for DVTs (Deep Vein Thromboses) right there in my little ‘ol brain.
So quick, do you remember?
Alright, how did you do? Check yourself at the bottom.
For those non-PT students out there, a DVT is a medical emergency !! So when my patient scored 4 points on this screen, I let my CI and the nurse know and a doppler was ordered that ultimately confirmed my suspicions. Luckily, once medicated my patient was just fine and we even got up and did some walking today. Emergencies can be nerve wracking but it is good to know that we are really quite prepared for all those scary red flags.
Wells Clinical Prediction Rule for Deep Venous Thrombosis (DVT)
|Active cancer (treatment within 6 months, or palliation)||1|
|Paralysis, paresis, or immobilization of lower extremity||1|
|Bedridden for more than 3 days because of surgery (within 4 weeks)||1|
|Localized tenderness along distribution of deep veins||1|
|Entire leg swollen||1|
|Unilateral calf swelling of greater than 3 cm (below tibial tuberosity)||1|
|Unilateral pitting edema||1|
|Collateral superficial veins||1|
|Alternative diagnosis as likely as or more likely than DVT||-2|
DVT = deep venous thrombosis.
Risk score interpretation (probability of DVT):
- >/=3 points: high risk (75%);
- 1 to 2 points: moderate risk (17%);
- <1 point: low risk (3%).