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Review: the Wells rule is more useful than individual clinical features for predicting risk of deep venous thrombosis

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 Q In patients with suspected deep venous thrombosis (DVT), how well do individual clinical features, structured risk scores, and physicians’ empirical judgments detect the presence or absence of DVT?

Clinical impact ratings GP/FP/Primary care ★★★★★★☆ IM/Ambulatory care ★★★★★☆☆ Internal medicine ★★★★★☆☆ Haematology ★★★★★☆☆ Emergency medicine ★★★★★☆☆


Embedded ImageData sources

Medline, EMBASE/Excerpta Medica, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Controlled Trails Register, Database of Reviews of Effectiveness, ACP Journal Club (to January 2005), and bibliographies of retrieved articles.

Embedded ImageStudy selection and assessment

diagnostic cohort studies (published as full articles or abstracts in English, French, Spanish, or Italian) that evaluated clinical findings, risk scores, and physicians’ empirical judgments compared with diagnosis by a reference standard (ultrasonography or venography) in patients with suspected DVT. Excluded were case control studies, studies with <10 patients, and those that assessed risk of DVT in the future. Evaluation of study quality included whether the reference standard was applied independently of the clinical assessment, and whether the observers of both the clinical assessment and the reference standard were blinded to the results of the other test.

Embedded ImageOutcomes

pooled positive and negative likelihood ratios (LRs).


54 cohorts from 51 studies were included in the meta-analysis. LRs were pooled using a random effects model. Clinical features that were useful or moderately useful in ruling in DVT were malignant disease, history of DVT, recent immobilisation, recent surgery, and a …

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  • For correspondence: Dr S Goodacre, University of Sheffield, Sheffield, UK. s.goodacre{at}

  • Source of funding: United Kingdom Health Technology Assessment R&D Programme.