title: Is time to search the Wells Score 4.0?
abstract: BACKGROUND
  Wells score for deep vein thrombosis presents problems for implementation in the hospital emergencies, mainly due to the complexity of its enforcement.
  
  
  OBJECTIVE
  To assess whether the inclusion of D-dimer as a predictor might lead to a simplification of this clinical decision rule.
  
  
  METHODS
  A database of deep vein thrombosis patients was studied by logistic regression model in which the 10 predictors in the Wells score and the dimer D were included. The diagnosis was made with compression ultrasonography with Doppler signal. D-dimer was determined by a quantitative method of latex, a technique immunofiltration or a turbidimetric technique.
  
  
  RESULTS
  577 patients (54.1% women) were studied, with a mean age of 66.7 (14.2) years. 25.1% were diagnosed with deep vein thrombosis. Only four variables were independent, building a weighted model with greater predictive ability (area under the curve) than the original model (0.844 vs. 0.751, p<0.001). Both models showed an acceptable safety, with a similar rate of failure (0.8% vs. 1%). The simplified model allowed to select a higher percentage of patients who could have benefited from the non performance of the imaging test (20.6% vs. 15.8%, p=0.039).
  
  
  CONCLUSIONS
  The introduction of D-dimer in a regression model simplifies the Wells score and maintain the same efficacy and safety, which could improve its implementation in the hospital emergencies.
authors.affiliation: Área de Medicina Interna, Hospital de Alta Resolución de Alcaudete, Jaén, España. Electronic address: fprosa@ephag.es.
authors.forename: F
authors.initials: F
authors.lastname: Rosa-Jiménez
authors.affiliation: Área de Urgencias, Hospital de Alta Resolución de Alcaudete, Jaén, España.
authors.forename: A
authors.initials: A
authors.lastname: Rosa-Jiménez
authors.affiliation: Área de Medicina Interna, Hospital de Alta Resolución de Puente Genil, Córdoba, España.
authors.forename: A
authors.initials: A
authors.lastname: Lozano-Rodríguez
authors.affiliation: Área de Urgencias, Hospital de Alta Resolución de Alcaudete, Jaén, España.
authors.forename: P
authors.initials: P
authors.lastname: Martín-Moreno
authors.affiliation: Área de Urgencias, Hospital de Alta Resolución de Alcaudete, Jaén, España.
authors.forename: M D
authors.initials: MD
authors.lastname: Hinojosa-Martínez
authors.affiliation: Área de Cardiología, Hospital de Montilla, Córdoba, España.
authors.forename: Á M
authors.initials: ÁM
authors.lastname: Montijano-Cabrera
keywords: Clinical decision rules, Wells score; D dimer; Deep vein thrombosis; Dímero D; Enfermedad tromboembólica venosa; Escala de Wells; Modelos clínicos; Trombosis venosa profunda; thromboembolic disease.