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Respiratory / Haematology

Wells Score for Pulmonary Embolism

Pre-test probability assessment for PE. Guides D-dimer and CTPA decision-making.

Wells PE Criteria
Tick each criterion present. Score guides pre-test probability.
Clinical signs/symptoms of DVT
Leg swelling, pain on palpation of deep veins
+3
PE is #1 diagnosis or equally likely
Alternative diagnosis less likely than PE
+3
Heart rate > 100 bpm
Tachycardia on assessment
+1.5
Immobilisation ≥3 days or surgery in last 4 weeks
Recent bed rest or operative procedure
+1.5
Previous DVT or PE
Documented prior thromboembolic event
+1.5
Haemoptysis
Coughing up blood
+1
Malignancy (active or treated in last 6 months)
Current or recent cancer diagnosis
+1
⚠️ Wells score must be used alongside clinical judgement and local PE pathway.
Wells PE Result
Wells PE Score
0
Low Probability

Wells Score for PE: The Complete Clinical Guide

Pre-test probability, D-dimer thresholds, CTPA indications, massive PE management and anticoagulation

What Is the Wells Score for PE?

The Wells score (Wells et al., 2001) is a validated clinical prediction rule for estimating the pre-test probability of pulmonary embolism. It stratifies patients into low (<2), moderate (2–6), or high (>6) probability groups, guiding the need for D-dimer testing and CTPA. It is endorsed by NICE NG158, ESC 2019, and forms the backbone of most hospital PE diagnostic pathways.

Key Rule
High probability (score >4 or >6 depending on version) → go straight to CTPA. Do not request D-dimer — it will not rule out PE at high pre-test probability and delays treatment.

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References

  1. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside. Ann Intern Med. 2001;135(2):98-107.
  2. NICE NG158. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. Updated 2023.
  3. Konstantinides SV et al. ESC Guidelines on acute pulmonary embolism. Eur Heart J. 2020;41(4):543-603.
  4. Righini M et al. Age-adjusted D-dimer cutoff levels to rule out PE. JAMA. 2014;311(11):1117-1124.

⚠️ Medical Disclaimer: For educational and documentation purposes only. PE is a life-threatening emergency — always use clinical judgement and local pathways. MedDraftPro accepts no clinical liability.

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