At the link above, note that a recent metanalysis has detected that one cannot rely on the DVT Wells rule alone in 2 important circumstances- active cancer and a history of previous DVT/PE. The Wells rule had an unacceptable (higher than 2%) false negative rate for these 2 subgroups, and as such D-Dimer testing for rule out was needed despite the low risk Wells.
While this affects ER care more than express care, it does reinforce these 2 points:
- When assessing patients with respiratory complaints in the express care and you are tallying history to rule out DVT (and also PE), thoroughly respect and lend credence to active cancer or previous thrombotic history.
- Again, always keep DVT/PE in the differential, and document as many points as possible against it if you do not send someone to the ER. Medicine will humble you through a PE or DVT.
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