Well’s criteria for Pulmonary Embolism probability assessment

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
Yes
No
Yes
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 DVT | Yes | 3 |
No | 0 | |
Alternative diagnosis less likely than PE | Yes | 3 |
No | 0 | |
Heart rate ≥ 100 b.p.m | Yes | 1.5 |
No | 0 | |
Immobilization or surgery within the past 4 weeks | Yes | 1.5 |
No | 0 | |
Previous, objectively diagnosed PE or DVT | Yes | 1.5 |
No | 0 | |
Haemoptysis | Yes | 1 |
No | 0 | |
Active cancer | Yes | 1 |
No | 0 |
Three Tier Model
Calculation result | Risk group | Points | Clinical advice |
Low probability | 0-1 points | Perform D-dimer testing: -if D-dimer testing is negative consider stopping workup, -if D-dimer testing is positive consider CT-angiography | |
Moderate probability | 2-6 points | Perform D-dimer testing: -if D-dimer testing is negative consider stopping workup, -if D-dimer testing is positive consider CT-angiography | |
High probability | ≥7 points | Consider CT-angiography |
Two Tier Model
Calculation result | PE probability | Points | Clinical advice |
PE unlikely | 0-4 points | Perform D-dimer testing: -if D-dimer testing is negative consider stopping workup, -if D-dimer testing is positive consider CT-angiography | |
PE likely | ≥5 points | Consider 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.
Register on our website right now to have access to more learning materials!
Multiple Myeloma Diagnostic Criteria – Online Calculator
Revised Multiple Myeloma International Staging System (R-ISS) Online Calculator
Revised Multiple Myeloma International Staging System (R-ISS) – prognostication tool for myeloma patients based on…
Multiple Myeloma International Staging System (ISS) Online Calculator
Multiple Myeloma International Staging System (ISS) prognosticates the severity of multiple myeloma based on routinely…
SAVED VTE Score
SAVED score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…
IMPEDE VTE Score
IMPEDE score for venous thromboembolism risk stratification in patients with multiple myeloma receiving immunomodulators. [ezfc…
Clinical Presentation Alzheimer Disease
Learning Objectives: 1. Discuss the differential diagnoses of dementia 2. Identify the clinical manifestations of…