What goes into the Wells score for PE
- Clinical signs of DVT (+3)
- PE is the most likely diagnosis (+3)
- Heart rate > 100 (+1.5)
- Immobilization ≥ 3 days or surgery in past 4 weeks (+1.5)
- Previous DVT or PE (+1.5)
- Hemoptysis (+1)
- Active cancer (treatment within 6 months or palliative) (+1)
How to interpret the result
- ≤ 4 points: PE unlikely; check a D-dimer (age-adjusted cutoff over age 50) and image only if positive
- > 4 points: PE likely; go straight to CTPA (or V/Q scan if contrast is contraindicated)
- Three-tier version: < 2 low, 2–6 moderate, > 6 high probability
Clinical pearls
- In low-suspicion patients, a negative PERC rule avoids testing altogether.
- Do not send a D-dimer when pre-test probability is high; a negative result does not exclude PE.
- If CTPA will be delayed and bleeding risk is low, start anticoagulation while waiting.
Evidence
- Wells PS, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism. Thromb Haemost. 2000;83:416-420.
- van Belle A, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006;295:172-179.
Related workups
Related calculators
For education only. Check the inputs and the population the score was validated in before acting on it. Not a substitute for clinical judgment.