Wells' Criteria for Pulmonary Embolism stratifies PE risk using clinical findings to guide diagnostic testing (e.g., D-dimer, CT pulmonary angiography). Scores categorize patients into Low, Moderate, or High probability groups.
Patient Data Entry Guide
Step 1: Input Clinical Criteria
- Clinical Signs of DVT: Swelling/pain in one leg (Yes/No).
- PE is the Most Likely Diagnosis: Alternative diagnoses less likely (Yes/No).
- Heart Rate >100 bpm (Yes/No).
- Immobilization or Surgery in Past 4 Weeks (Yes/No).
- Previous DVT/PE (Yes/No).
- Hemoptysis (Yes/No).
- Active Malignancy (Yes/No).
Step 2: Input Symptoms
- Symptoms: Describe relevant symptoms (e.g., chest pain, dyspnea).
- Example: Sudden-onset dyspnea, pleuritic chest pain
Sample Diagnostic Report
Wells' Score Calculation
- Input Data:
- Clinical Signs of DVT: Yes (+3)
- PE Most Likely Diagnosis: Yes (+3)
- Heart Rate >100 bpm: Yes (+1.5)
- Immobilization/Surgery: No (0)
- Previous DVT/PE: No (0)
- Hemoptysis: Yes (+1)
- Malignancy: No (0)
- Total Score:3+3+1.5+1=8.5 Points3+3+1.5+1=8.5 Points
Interpretation
- Clinical Probability: High (>6 Points).
- PE Risk: >40% likelihood of PE in this category.
Symptom Correlation
- Sudden dyspnea and pleuritic pain are classic PE symptoms.
Recommendations
- Immediate Imaging: Perform CT pulmonary angiography (CTPA) or ventilation-perfusion (V/Q) scan.
- Do Not Delay Treatment: Start anticoagulation (e.g., heparin) if imaging is delayed.
- Assess for DVT: Perform lower extremity Doppler ultrasound.
Key Considerations
- Score Ranges:
- Low Probability: ≤4 Points.
- Moderate Probability: 4.5–6 Points.
- High Probability: >6 Points.
- Limitations:
- Subjective components (e.g., "PE is most likely diagnosis").
- Not validated for inpatients or critically ill patients.
- D-Dimer Use:
- Low/Moderate Probability: Use D-dimer to rule out PE (negative D-dimer excludes PE).
- High Probability: Proceed directly to imaging.
Clinical Probability Categories
| Wells' Score | Probability | PE Prevalence | Management |
|---|---|---|---|
| ≤4 | Low | 5–10% | D-dimer → Imaging if positive |
| 4.5–6 | Moderate | 20–30% | D-dimer → Imaging if positive |
| >6 | High | 40–80% | Immediate imaging + anticoagulation |
Equations
Wells' Criteria Scoring:
Final Diagnosis: Combines Wells' Score and symptoms to prioritize PE evaluation (e.g., high-probability patients require urgent imaging, while low-probability patients may avoid radiation with D-dimer testing).
✅ Score Validation:
- Maximum possible score: 12.5 points.
- High Probability: >6 points correlates with ≥40% PE prevalence in studies.