Wells criteria

Background

Used to determine pre-test probability when evaluating patients for possible pulmonary embolism.

Clinical Features	Points
Symptoms of DVT (leg swelling and pain with palpation)	3.0
PE as likely as or more likely than an alternative diagnosis	3.0
HR >100 bpm	1.5
Immobilization for >3 consecutive days or surgery in the previous 4 weeks	1.5
Previous DVT or PE	1.5
Hemoptysis	1.0
Malignancy (receiving treatment, treatment stopped within 6 mon, palliative care)	1.0

Score 0-4 = PE Unlikely (12.1% incidence of PE)
- Check D-dimer
  - If D-dimer positive then obtain CTPA or V/Q scan
  - If D-dimer negative, no further workup needed (0.5% incidence of PE at 3 month follow up)
Score >4 = PE Likely (37.1% incidence of PE)
- Obtain CT Pulmonary Angiography or V/Q Scan
New evidence suggests lower Wells Score with D-dimer <1000 ng/mL is effective at ruling out PE without imaging

Diagnosis of Pulmonary Embolism With D-Dimer Adjusted to Clinical Probability. N Engl J Med 2019;381:2125-2134. https://www.nejm.org/doi/full/10.1056/NEJMoa1909159

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