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Well’s criteria for Pulmonary Embolism probability assessment

Nataliia Lopina May 23, 2021
probability of PE, Wells scale, thromboembolism, pulmonary embolism

The Wells’ Criteria risk stratifies patients for pulmonary embolism (PE) and provides an estimated pre-test probability. The physician based on the Wells’ Criteria risk assessment can then chose what further testing is required for diagnosing pulmonary embolism (I.E. d-dimer or CT angiogram).


Yes
No

Yes
No

Yes
No

Yes
No

Yes
No

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No

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No


Risk group Points Clinical advice
0 0 0

PE probability Points Clinical advice
0 0 0

The Wells’ Criteria:

  Points
Clinical signs and symptoms of DVTYes3
 No0
Alternative diagnosis less likely than PEYes3
 No0
Heart rate ≥ 100 b.p.mYes1.5
 No0
Immobilization or surgery within the past 4 weeksYes1.5
 No0
Previous, objectively diagnosed PE or DVTYes1.5
 No0
HaemoptysisYes1
 No0
Active cancerYes1
 No0

Three Tier Model

Calculation resultRisk groupPointsClinical advice
 Low probability0-1 pointsPerform D-dimer testing: -if D-dimer testing is negative consider stopping workup, -if D-dimer testing is positive consider CT-angiography
 Moderate probability2-6 pointsPerform D-dimer testing: -if D-dimer testing is negative consider stopping workup, -if D-dimer testing is positive consider CT-angiography
 High probability≥7 pointsConsider CT-angiography  

Two Tier Model

Calculation resultPE probabilityPointsClinical advice
 PE unlikely  0-4 pointsPerform D-dimer testing: -if D-dimer testing is negative consider stopping workup, -if D-dimer testing is positive consider CT-angiography
 PE likely≥5 pointsConsider CT-angiography

he Wells’ Score has been validated multiple times in multiple clinical settings.

  • Physicians have a low threshold to test for pulmonary embolism.
  • The score is simple to use and provides clear cutoffs for the predicted probability of pulmonary embolism.
  • The score aids in potentially reducing the number of CTAs performed on low-risk PE patients.

Resources:

  • Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, Forgie M, Kovacs G, Ward J, Kovacs MJ. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001 Jul 17;135(2):98-107. doi: 10.7326/0003-4819-135-2-200107170-00010. PMID: 11453709.
  • Wolf SJ, McCubbin TR, Feldhaus KM, Faragher JP, Adcock DM. Prospective validation of Wells Criteria in the evaluation of patients with suspected pulmonary embolism. Ann Emerg Med. 2004 Nov;44(5):503-10. doi: 10.1016/j.annemergmed.2004.04.002. PMID: 15520710.
  • van Belle A, Büller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW, Kramer MH, Kruip MJ, Kwakkel-van Erp JM, Leebeek FW, Nijkeuter M, Prins MH, Sohne M, Tick LW; Christopher Study Investigators. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006 Jan 11;295(2):172-9. doi: 10.1001/jama.295.2.172. PMID: 16403929.

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Categories: Cardiology, Online calculators, Pulmonary embolism assessment

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