Wells criteria for pulmonary embolism

The Wells criteria for pulmonary embolism is a risk stratification score and clinical decision rule to estimate the probability for acute pulmonary embolism (PE) in patients in which history and examination suggests acute PE is a diagnostic possibility. It provides a pre-test probability which, if deemed unlikely, can then be used in conjunction with a negative D-dimer to rule out PE avoiding imaging .

Criteria

• clinical signs and symptoms of DVT = 3
• an alternative diagnosis is less likely than PE = 3
• heart rate more than 100 = 1.5
• immobilization for 3 or more consecutive days or surgery in the previous 4 weeks = 1.5
• previous objectively diagnosed PE or DVT = 1.5
• hemoptysis = 1
• malignancy (on treatment, treatment in last 6 months or palliative) = 1

Interpretation

Can be applied in either three tier or two tier models:

Three tier:

• 0-1: low risk
• 2-6: moderate risk
• >6: high risk

Two tier:

• ≤4: unlikely
• ≥4.5: likely

In the three tier model:

• low risk patients: pulmonary embolism rule-out criteria (PERC) can be considered as well as D-dimer
• moderate risk: consider D-dimer or CT pulmonary angiography
• high risk: D-dimer not recommended

In the two tier model:

• unlikely: consider D-dimer
• likely: consider CTPA

See also

• Wells criteria for deep venous thrombosis
• Geneva score for PE
• pulmonary embolism rule-out criteria (PERC)

Siehe auch:

• Lungenarterienembolie
• Score für die tiefe Venenthrombose

und weiter:

• Emboliescore