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%).
References:
- 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]
- 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
