Wells Score for Pulmonary Embolism

Wells PE rule (Wells 2000); two-tier per Wells 2001/Christopher Study

Scores seven bedside items to classify suspected pulmonary embolism as unlikely or likely (two-tier) or low/moderate/high (three-tier), directing the workup to D-dimer testing or straight to imaging.

Also searched as: PE · pre-test probability · D-dimer · CTPA · decision rule · pretest

Lower concern

Wells PE 0 — PE unlikely (low probability)

Score: 0

Total score: 0 of 12.5 possible points.
Two-tier: PE unlikely (cutoff 4).
Three-tier: low probability (low 0-1, moderate 2-6, high > 6).
No criteria present.
PE unlikely: high-sensitivity D-dimer is the usual next step (age-adjusted cutoff when > 50 y); image only if positive. If gestalt is low, also consider the PERC rule first.

Caveats

A probability estimate, not a diagnosis; clinician gestalt may override the rule.
The simplified 1-point-per-item variant (unlikely <= 1) is not implemented here.

How this tool works

The Wells PE rule weights clinical signs of DVT and the clinician's judgment that PE is the leading diagnosis at 3 points each; heart rate over 100, recent immobilization or surgery, and prior venous thromboembolism at 1.5 each; and hemoptysis and active cancer at 1 each. In the dichotomized scheme a total of 4 or less makes PE unlikely (proceed with a high-sensitivity D-dimer; image only if positive), while more than 4 makes PE likely (proceed to CT pulmonary angiography or VQ scanning). The original three-tier scheme reads 0-1 as low, 2-6 as moderate, and above 6 as high probability.

References

Implemented from the cited published sources. Educational use only; confirm against current guidelines before clinical use.

Clinical questions that use this

Vetting guides that reach for this tool.

Suspected acute pulmonary embolism

Related calculators

Same subspecialty, overlapping subject matter.

Revised Geneva Score for Pulmonary Embolism Wells Score for Deep Vein Thrombosis PERC Rule (Pulmonary Embolism Rule-out Criteria)