Wells Clinical Prediction Rule for Pulmonary Embolism and Deep Venous Thrombosis

Wells Clinical Prediction Rule for Pulmonary Embolism (PE) 

 

Clinical feature	Points
Clinical symptoms of DVT	3
Other diagnosis less likely than PE	3
Heart rate greater than 100 beats per minute	1.5
Immobilization or surgery within past 4 weeks	1.5
Previous DVT or PE	1.5
Hemoptysis	1
Malignancy	1
Total points

 

PE = pulmonary embolism; DVT = deep venous thrombosis.

Risk score interpretation (probability of PE):

• >6 points: high risk (78.4%);
• 2 to 6 points: moderate risk (27.8%);
• <2 points: low risk (3.4%)

 

Wells Clinical Prediction Rule for Deep Venous Thrombosis (DVT) 

Clinical feature	Points
Active cancer (treatment within 6 months, or palliation)	1
Paralysis, paresis, or immobilization of lower extremity	1
Bedridden for more than 3 days because of surgery (within 4 weeks)	1
Localized tenderness along distribution of deep veins	1
Entire leg swollen	1
Unilateral calf swelling of greater than 3 cm (below tibial tuberosity)	1
Unilateral pitting edema	1
Collateral superficial veins	1
Alternative diagnosis as likely as or more likely than DVT	-2
Total points

DVT = deep venous thrombosis.

Risk score interpretation (probability of DVT):

• >/=3 points: high risk (75%);
• 1 to 2 points: moderate risk (17%);
• <1 point: low risk (3%).

References:

1. Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000 Mar;83(3):416-20. [Medline]
2. Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L, Clement C, Robinson KS, Lewandowski B. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997 Dec 20-27;350(9094):1795-8. [Medline]