End
Wells’ Criteria for PE
Objectifies risk of pulmonary embolism (PE). Helps guide diagnostic workup by predicting pre-test probability (d-dimer vs. CT angiogram).
Clinical signs and symptoms of DVT
PE is #1 diagnosis OR equally likely
Heart rate > 100
Immobilization (≥ 3 days) or surgery in previous 4 weeks
Previous, objectively diagnosed PE or DVT
Hemoptysis
Malignancy w/ treatment within 6 months or palliative
0
Points
Analyzing Risk…
3-Tier Incidence: -%
2-Tier Interpretation: -%
| Score (3-Tier) | Risk Group | Recommended Action |
|---|---|---|
| 0 – 1 | Low Risk | Consider d-dimer testing to rule out PE. Alternatively, consider PERC rule. |
| 2 – 6 | Moderate Risk | Consider high sensitivity d-dimer testing or CTA. |
| > 6 | High Risk | Consider CTA. D-dimer testing is not recommended. |
1
Clinical Suspicion First: There must first be a clinical suspicion for PE before applying the Wells’ Criteria. It should not be universally applied to all patients presenting with chest pain or shortness of breath.
2
Subjectivity: The tool is often criticized for the subjective criterion “PE is #1 diagnosis or equally likely,” relying heavily on clinician gestalt.
3
Age-Adjusted D-Dimer: For patients > 50 years in low-risk groups, age-adjusted d-dimer cutoffs have been validated. Consider: Age (years) × 10 µg/L = cutoff.
4
Diagnostic Testing: Never delay resuscitative efforts for diagnostic testing, especially in unstable patients.
