Background: The Jewish General Hospital Clinical Access Service (CAS) is a rapid referral clinic for the diagnosis of deep vein thrombosis (DVT) in Montreal, Canada. Ambulatory patients with suspected DVT are referred with a physician completed Wells score. A modified Wells score < 2 suggests DVT is unlikely and ≥ 2 suggests DVT is likely. Depending on the score, patients may undergo d-dimer testing with or without venous doppler ultrasound (DUS) or DUS alone. The CAS registered nurses were recently trained to use the Wells score.
Aims: To determine correlation and agreement between physician (MD) and registered nurses (RN) assigned Wells scores in patients with suspected DVT in an outpatient setting.
Methods: RNs assessed the Wells score of 141 patients with suspected DVT between April 15thand December 28th, 2020. RNs were blinded to physician scores. Physician and registered nurses scores agreement was determined by Pearson Correlation. Proportions were used to describe concordance of unlikely (<2) and likely (≥ 2) scores.
Results: RNs assessed the Wells score of 141 patients with suspected DVT between April 15thand December 28th, 2020. RNs were blinded to physician scores. Physician and registered nurses scores agreement was determined by Pearson Correlation. Proportions were used to describe concordance of unlikely (<2) and likely (≥ 2) scores.
| Wells score assignment physicians and registered nurses (n, %) | |||
| Physician scores | Registered nurse scores | ||
| Modified Wells score < 2 | 63 (44.7) | 97 (68.8) | |
| Modified Wells score ≥ 2 | 78 (55.3) | 44 (31.2) | |
| Total (n) | 141 | ||
| Agreement between physician and registered nurse Wells scores (n, %) | |||
| Concordance | Discordance | Total | |
| Physician and registered n nurse Wells score < 2 | 61(96.8) | 2 (3.2) | 63 (44.6) |
| Physician and registered n nurse Wells score ≥ 2 | 42 (53.8) | 36 (46. 2) | 78 (55.3) |
Physician and registered nurse Wells score assignment and agreement.
Conclusions: We observed moderate interobserver agreement between physician and RN for the use of Wells scores as part of a DVT assessment algorithm in a fast-track clinic. Discordance was more frequent among patients assessed with a high DVT risk. Future studies are needed to better understand the use of the Wells score in a fast-track outpatient clinic according to assessor.
To cite this abstract in AMA style:
Martínez C, Rossignol B, Zwetkow M, Tagalakis V. Agreement between Physician and Nurse Derived Wells Score as Part of the Assessment of Deep Vein Thrombosis in a Rapid Access Ambulatory Clinic [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/agreement-between-physician-and-nurse-derived-wells-score-as-part-of-the-assessment-of-deep-vein-thrombosis-in-a-rapid-access-ambulatory-clinic/. Accessed November 29, 2023.« Back to ISTH 2021 Congress
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