Wells PE Score

PulmonologyPhilip S. Wells and colleagues

The Wells Score for Pulmonary Embolism was developed by Dr. Philip Wells and colleagues in 2000 to provide a standardised, reproducible clinical pretest probability assessment for PE, enabling rational use of D-dimer and CT pulmonary angiography (CTPA). Two versions exist: the original "three-tier" (low/moderate/high probability) and the simplified "two-tier" (PE unlikely vs PE likely) version. The score was derived from emergency department cohorts in Canada and subsequently validated in multiple international studies. It is the most widely used PE pretest probability tool, integrated into major diagnostic algorithms (PERC, Christopher, YEARS).

9 criteria6 pearls3 refsValidated

Wells DVT Score

PulmonologyPhilip S. Wells and colleagues

Open

The Wells DVT Score is a validated clinical decision tool developed by Dr. Philip Wells to stratify pretest probability for deep vein thrombosis (DVT) in outpatients presenting with leg symptoms. It was designed to guide rational use of D-dimer testing and duplex ultrasound, reducing unnecessary imaging. The score incorporates nine clinical variables related to risk factors, examination findings, and alternative diagnoses. It was derived from prospective ED cohort studies and validated in multiple settings internationally.

10 criteria5 pearls3 refsValidated

Validated In

Prospective study of 593 outpatients with suspected DVT; multiple international cohorts

Philip S. Wells and colleagues

Active cancer (treatment within 6 months or palliative)

+1 point

Paralysis, paresis, or recent lower extremity cast

+1 point

Bedridden ≥3 days OR major surgery within 12 weeks

+2 points

Localised tenderness along deep venous system

+1 point

Entire leg swollen

+1 point

Calf swelling >3 cm compared to asymptomatic leg

+1 point

Pitting oedema (greater in symptomatic leg)

+1 point

Collateral superficial veins (non-varicose)

+1 point

Alternative diagnosis at least as likely as DVT

-2 points

Score ≤1 = Low probability (~5%), 2-2 = Moderate (~17%), ≥3 = High (~53%)

Low probability (≤1) + negative high-sensitivity D-dimer: safely rules out DVT without imaging (NPV >98%).

High probability (≥3): proceed directly to duplex ultrasound without waiting for D-dimer result.

Age-adjusted D-dimer (age × 10 μg/L for patients >50 years) increases specificity while maintaining sensitivity.

Anticoagulation decision in suspected DVT: start therapeutic anticoagulation in high-probability patients while awaiting imaging if bleeding risk is acceptable.

Isolated distal (calf) DVT: serial ultrasound monitoring at 5-7 days is an alternative to immediate anticoagulation in low-risk patients.

[1]

Wells PS, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350(9094):1795-1798.

[2]

Wells PS, et al. Does this patient have deep vein thrombosis? JAMA. 2006;295(2):199-207.

[3]

Konstantinides SV, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2020;41(4):543-603.

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Wells PE Score

Wells DVT Score