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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]

 

Created: April 13, 2006
Last Modified: 04/13/2006