Unifying Concepts

Wells Clinical Prediction Rule for Pulmonary Embolism and Deep Venous Thrombosis

The Wells Clinical Prediction Rule is a diagnostic tool used during review of systems to identify possible pulmonary embolism (PE) and deep vein thrombosis (DVT).

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 oedema 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%).




  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

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