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 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|
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)
|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|
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%).
- 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