The Accuracy of Wells Clinical Model for Predicting Pretest Probability in Deep Vein Thrombosis (DVT) at Dr. Sardjito Hospital

Dwi Wulansih(1*), Johan Kurnianda(2), Kartika Widayati(3)

(*) Corresponding Author


Background: The diagnosis of deep vein thrombosis (DVT) is an important issue in the medical field because a large number of cases are undiagnosed. The accurate diagnosis of the DVT is essential to prevent complications of acute pulmonary embolism and long-term complications. The complication such as pulmonary hypertension and post phlebitis syndrome. It also to avoid improper anticoagulant therapy associated with a high risk of bleeding. There are several models of clinical suspicion of DVT include Hamilton’s score and Wells’ score. The Wells clinical model for predicting pretest probability for DVT has been widely used and tested its validity in several countries in Europe. The accuracy of a Wells clinical model of pretest probability for DVT has not been done for the races of Asia especially in Indonesia.
Objective: This study aimed to test the accuracy and precision (sensitivity, specificity and predictive value) of Wells clinical model for predicting pretest probability for diagnose DVT for patients in the Dr. Sardjito Hospital.
Methods: This study was a diagnostic study with cross-sectional design. The subjects were patients with DVT symptoms who visited Tulip clinic, outpatient and inpatient in the department of Dr. Sardjito General Hospital during January 2011-May 2012. In this study, a total of 100 patients were participated the Wells clinical model of pretest probability for DVT examination, Doppler ultrasound and D-dimer examination. The negative results on the fi rst ultrasound examination will be examined again 1 week later.
Results: DVT was confi rmed in 56 patients (56%) from 100 patients. The baseline characteristics showed the number of women more than men and the mean age was 52.98 ±1.335 years. The 57% of subjects were women and the median age was ≥60 years. The most frequent risk factors of DVT were cancer 49 patients (49%), bed ridden 42 patients (42%) and elderly 33 patients (33%). The accuracy of the Wells clinical model of pretest probability for DVT was 81%, precision was 77.6%, sensitivity was 92.8%, specifi city was 65.9%, and negative predictive value was 87.9%.
Conclusion: The Wells clinical model for predicting pretest probability in DVT has a high accuracy, moderate precision, high sensitivity and poor specifi city to diagnose DVT at Dr. Sardjito Hospital.
Keywords: deep vein thrombosis/DVT, the Wells clinical model of pretest probability for DVT, accuracy test, precision

Full Text:




Lopez JA, Kearon C., Lee Deep Venous Thrombosis AAY. American Society of Hematology 2004; 1:439-56

Kesieme E., Kesieme C., Jebbin N., Irekpita E., A. Dongo Deep Vein Thrombosis: A Clinical Review. Journal of Blood Medicine 2011; 2:59-69

Wells P., Hirsh J, Anderson DR, Lensing AWA, Foster G, Kearon C. Accuracy of Clinical Assessment of Deep Vein Thrombosis. Lancet 1995. ; 345:1326-30

P. Wells, DR Anderson, J. Bormanis Value of assessment of pretest probability of deep-vein thrombosis in Clinical Management. Lancet 1997; 350:1795-801

Purwanto T. Risk Factors and Diagnosis of Venous Thrombosis In particular vein The Journal of Internal Medicine, Acta Interna, Volume 4, Number 1, June 2014: 1-7 and pulmonary embolism in Trombo-Full Text VI Annual Scientifi c Meeting of Medicine 2004; 115-132

Scarvelis D. & Wells PS Diagnosis and Treatment of Deep-Vein Thrombosis. CMAJ 2006; 175 (9) :1087-91

Constan J., Boutinet C., Salmi LR, J. Saby, Nelzy M., P. Baudouin et al. Comparison of Four Clinical Prediction Scores for the Diagnosis of Lower Limb Deep Venous Thrombosis in Outpatients. Am J Med 2003; 115:436-40

McGinn T., Guyatt G, Wyer P. Users Guide to the Medical Literature: XXII: How to Use Articles about Clinical Decision Rules. JAMA 2000; 284:79-84


Article Metrics

Abstract views : 371 | views : 204


  • There are currently no refbacks.

Copyright (c) 2014 Acta Interna The Journal of Internal Medicine

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Acta Interna The Journal of Internal Medicine Indexed by:


 Indonesia Onesearch Google Scholar IPI Indonesian Publication Index

 website statistics View My Stats  



Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.