A 75-year-old man hospitalized 4 days ago with congestive heart failure now has new mild right-sided leg pain. Examination reveals bilateral pitting edema to the mid-thighs; the right leg is 3.5 cm larger than the left leg, which is measured 10 cm below the tibial tuberosity. There is no significant tenderness to palpation. The patient has no known malignant neoplasms. His mobility has been limited for the past month owing to his heart failure, and he has not ambulated since admission other than to use the bathroom. Vital signs are unchanged and the patient reports that his dyspnea has improved with diuresis. Lower-extremity ultrasound will not be available overnight.
Price EL, Minichiello T. The Wells Deep Vein Thrombosis Score for InpatientsNot the Right Tool for the Job. JAMA Intern Med. 2015;175(7):1118-1119. doi:10.1001/jamainternmed.2015.1699