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Wells scoring system for pulmonary embolism

simplified version observation score signs/symptoms for DVT* 3.0 no alternative diagnosis 3.0 heart rate > 100/min 1.5 immobilization or surgery in past 4 weeks 1.5 previous history of DVT or pulmonary emboli 1.5 hemoptysis 1.0 cancer actively treated within last 6 months 1.0 * signs/symptoms for deep vein thrombosis (DVT): leg swelling, leg pain, palpation of deep vein in leg Interpretation: - risk of pulmonary embolism a) low: < 2 b) moderate: 2-6 c) high: > 6 - PE is typically ruled out when the Wells score is <= 4 & the plasma D-dimer is <= 500 ug/L - using an age-adjusted plasma D-dimer threshold* may improve predictive value [4] - if PERC score is 0, no plasma D-dimer indicated [1] * age 10 ug/L in patients > 50 years Management: - patients with low probability Wells score should have plasma D-dimer testing, unless PERC score is 0 [1] - no imaging necessary if results are normal - patients with high probability Wells score should undergo CT angiography without plasma D-dimer testing

Related

Pulmonary Embolism Rule-Out Criteria (PERC)

General

Wells clinical prediction rules

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 15, 17, 18. American College of Physicians, Philadelphia 2009, 2015, 2018
  2. Chunilal SD et al Does this patient have pulmonary embolism? JAMA. 2003 Dec 3;290(21):2849-58. PMID: 14657070
  3. Schouten HJ, Geersing GJ, Oudega R et al. Accuracy of the Wells clinical prediction rule for pulmonary embolism in older ambulatory adults. J Am Geriatr Soc. 2014;62(11):2136-2141 PMID: 25366538
  4. van Es N et al. Wells rule and d-dimer testing to rule out pulmonary embolism: A systematic review and individual-patient data meta-analysis. Ann Intern Med 2016 May 17 PMID: 27182696