Wells scoring system for pulmonary embolism
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Introduction
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
- low: < 2
- moderate: 2-6
- 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
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 15, 17, 18. American College of Physicians, Philadelphia 2009, 2015, 2018
- ↑ Chunilal SD et al Does this patient have pulmonary embolism? JAMA. 2003 Dec 3;290(21):2849-58. PMID: https://www.ncbi.nlm.nih.gov/pubmed/14657070
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/25366538
- ↑ 4.0 4.1 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: https://www.ncbi.nlm.nih.gov/pubmed/27182696