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 1.

Criteria

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

Score 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
Share article

Article information

rID: 53684
Synonyms or Alternate Spellings:
  • Wells score
  • Wells criteria

Support Radiopaedia and see fewer ads

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.