Wells criteria
Background
Used to determine pre-test probability when evaluating patients for possible pulmonary embolism.
Criteria and Score
Wells Criteria
| Clinical Features | Points |
|---|---|
| Symptoms of DVT (leg swelling and pain with palpation) | 3.0 |
| PE as likely as or more likely than an alternative diagnosis | 3.0 |
| HR >100 bpm | 1.5 |
| Immobilization for >3 consecutive days or surgery in the previous 4 weeks | 1.5 |
| Previous DVT or PE | 1.5 |
| Hemoptysis | 1.0 |
| Malignancy (receiving treatment, treatment stopped within 6 mon, palliative care) | 1.0 |
Two Tier Wells Score
- Score 0-4 = PE Unlikely (12.1% incidence of PE)
- Check D-dimer
- If D-dimer positive then obtain CTPA or V/Q scan
- If D-dimer negative, no further workup needed (0.5% incidence of PE at 3 month follow up)
- Check D-dimer
- Score >4 = PE Likely (37.1% incidence of PE)
- Obtain CT Pulmonary Angiography or V/Q Scan
- New evidence suggests lower Wells Score with D-dimer <1000 ng/mL is effective at ruling out PE without imaging
See Also
External Links
References
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