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Is the Wells rule sufficiently sensitive to help exclude deep venous thrombosis (DVT) in all patients? To find out, investigators performed a meta-analysis of individual patient data obtained from the authors of 13 studies of outpatients with suspected DVT in four countries. The researchers assessed the combination of a Wells score ≤ 1 (unlikely) and a negative d-dimer result for ruling out DVT in different subgroups of patients.
Of 10,000 patients, 19% had DVT. Higher Wells scores were associated with higher DVT probability. Overall, 29% of patients had a Wells score ≤ 1 and a negative d-dimer result; the incidence of DVT was 1.2%, which is below the study-assigned 2% threshold for exclusion of the diagnosis. However, among patients with ca…