Wells_Criteria_PE v.1
Quantifies the risk of Pulmonary Embolism (PE)
The Well's criteria for PE quantifies the pre-test probability of the risk of PE and helps to group patients according to this risk allowing the physician to direct further investigation appropriately.
This tools helps clinicians make more directed approaches to stratifying patients for suspected PE and reduces the need for unnecessary CT angiograms (CTA). The tool scores 7 variables as shown below: Clinical signs and symptoms of DVT: +3 PE is #1 diagnosis OR equally likely: +3 Heart rate > 100: +1.5 Immobilization at least 3 days OR surgery in the Previous 4 weeks: +1.5 Previous, objectively diagnosed PE or DVT: +1.5 Hemoptysis: +1 Malignancy w/ treatment within 6 months or palliative: +1 The total score ranges from 0-12.5 Management follows a 3 or 2 tier model with the latter related to likely or unlikely PE with this grouping leading to testing by either d-Dimer or CTA. 3 Tier Model: Score 0-1: Low Risk (1.3% risk prevalence) Score 2-6: Moderate Risk (16.2% risk prevalence) Score >6: High Risk (37.5% risk prevalence) 2 Tier Model: Score ≤4: PE Unlikely (with d-dimer) (12.1% risk incidence) Score ≥5: PE Likely (with CTA) (37.1% risk incidence)
This tool should not be used to diagnose PE but to help direct the work-up to rule out the diagnosis of PE.
Ref. 1: Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, Forgie M, Kovacs G, Ward J, Kovacs MJ. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001 Jul 17;135(2):98-107. PubMed PMID: 11453709. Ref. 2: Wolf SJ, McCubbin TR, Feldhaus KM, Faragher JP, Adcock DM. Prospective validation of Wells Criteria in the evaluation of patients with suspected pulmonary embolism. Ann Emerg Med. 2004 Nov;44(5):503-10. PubMed PMID: 15520710
OBSERVATION.pulse.v2, OBSERVATION.wells_criteria_for_pulmonary_embolism.v1, EVALUATION.wells_criteria_for_pe_assessment.v1
