Wells Criteria for Pulmonary Embolism

Select all criteria that apply to the patient. A score ≥ 2 suggests moderate to high probability of PE.

Clinical signs and symptoms of DVT

Leg swelling, pain with palpation of the deep veins

Alternative diagnosis less likely than PE

No other diagnosis that explains the symptoms as well as PE

Heart rate > 100 beats per minute

+1.5

Tachycardia on presentation

Immobilization or surgery in the previous 6 weeks

+1.5

Bed rest ≥ 3 days or major surgery requiring general/regional anesthesia

Previous DVT or PE

+1.5

History of documented deep vein thrombosis or pulmonary embolism

Hemoptysis

Coughing up blood

Malignancy

Active cancer (treatment ongoing, within 6 months, or palliative)

Clinical Notes:

• Score < 2: Low probability (1.3% prevalence)
• Score 2-6: Moderate probability (16.2% prevalence)
• Score > 6: High probability (37.5% prevalence)
• D-dimer testing is most useful in low and moderate probability cases
• High probability cases may proceed directly to imaging

Wells Criteria for Pulmonary Embolism

The Wells Criteria for Pulmonary Embolism is a validated clinical prediction rule used to assess the probability of pulmonary embolism (PE) in patients presenting with symptoms suggestive of PE. This tool helps clinicians make informed decisions about diagnostic testing and treatment strategies.

Scoring Criteria

The Wells Criteria assigns points based on clinical features and risk factors:

Clinical Feature	Points
Clinical signs and symptoms of DVT	+3.0
Alternative diagnosis less likely than PE	+3.0
Heart rate > 100 beats per minute	+1.5
Immobilization or surgery in the previous 6 weeks	+1.5
Previous DVT or PE	+1.5
Hemoptysis	+1.0
Malignancy (treatment ongoing, within 6 months, or palliative)	+1.0

Probability Stratification

Score	Probability	Prevalence of PE
< 2.0	Low	1.3%
2.0 - 6.0	Moderate	16.2%
> 6.0	High	37.5%

Clinical Application and Management

The Wells Criteria helps guide diagnostic strategies:

Low Probability (< 2 points):
- Consider D-dimer testing first
- If D-dimer is negative, PE can be safely ruled out
- If D-dimer is positive, consider imaging studies
Moderate Probability (2-6 points):
- Consider D-dimer testing and/or imaging studies
- CT pulmonary angiogram or V/Q scan may be appropriate
- Clinical judgment should guide the diagnostic approach
High Probability (> 6 points):
- Consider immediate imaging studies
- D-dimer testing may not be necessary
- High clinical suspicion warrants prompt evaluation

Important Considerations

The Wells Criteria should be used as part of a comprehensive clinical assessment:

It is most useful when combined with other clinical information
The score helps reduce unnecessary imaging in low-probability cases
It should not replace clinical judgment in high-risk situations
Consider patient-specific factors that may not be captured by the score

This tool has been extensively validated and is widely used in emergency departments and other acute care settings to help manage patients with suspected pulmonary embolism.

References

Wells, P. S., Anderson, D. R., Rodger, M., Ginsberg, J. S., Kearon, C., Gent, M., ... & Kovacs, M. J. (2000). Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thrombosis and haemostasis, 83(3), 416-420.
Wells, P. S., Anderson, D. R., Rodger, M., Stiell, I., Dreyer, J. F., Barnes, D., ... & Kovacs, M. J. (2001). 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. Annals of internal medicine, 135(2), 98-107.
Le Gal, G., Righini, M., Roy, P. M., Sanchez, O., Aujesky, D., Bounameaux, H., & Perrier, A. (2006). Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Annals of internal medicine, 144(3), 165-171.
Kearon, C., Akl, E. A., Comerota, A. J., Prandoni, P., Bounameaux, H., Goldhaber, S. Z., ... & Kahn, S. R. (2012). Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2_suppl), e419S-e496S.

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