Well’s criteria for Pulmonary Embolism probability assessment

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

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 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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