The Wells Scores (DVT & PE)
The Wells Scores are validated clinical prediction rules used to estimate the pre-test probability of two distinct but related conditions: Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE).
Wells Score for Deep Vein Thrombosis (DVT)
This scoring system categorizes the likelihood of a lower extremity DVT.
Active cancer (treatment ongoing, within previous 6 months, or palliative) (+1 point)
Paralysis, paresis, or recent plaster immobilization of the lower extremities (+1 point)
Recently bedridden for 3 days or more OR major surgery within previous 12 weeks requiring regional or general anesthesia (+1 point)
Localized tenderness along the distribution of the deep venous system (+1 point)
Entire leg swollen (+1 point)
Calf swelling at least 3 cm larger than asymptomatic side (measured 10 cm below tibial tuberosity) (+1 point)
Pitting edema confined to the symptomatic leg (+1 point)
Collateral superficial veins that are non-varicose (+1 point)
Previously documented DVT (+1 point)
Alternative diagnosis is at least as likely as DVT (-2 points)
DVT Clinical Stratification & Management
Traditional 3-Tier Model:
Score 0: Low Probability (D-dimer testing to rule out).
Score 1–2: Moderate Probability (High-sensitivity D-dimer or ultrasound).
Score 3 or more: High Probability (Proceed directly to venous duplex ultrasound).
Simplified 2-Tier Model:
Score less than 2: DVT Unlikely.
Score 2 or more: DVT Likely.
Wells Score for Pulmonary Embolism (PE)
This tool is used exclusively when a patient presents with acute dyspnea, chest pain, or other symptoms suggestive of a PE.
Clinical signs and symptoms of DVT (objective swelling and pain with palpation) (+3.0 points)
An alternative diagnosis is less likely than pulmonary embolism (+3.0 points)
Heart rate greater than 100 beats per minute (+1.5 points)
Immobilization for 3 days or more OR surgery within the previous 4 weeks (+1.5 points)
Previous objectively diagnosed PE or DVT (+1.5 points)
Hemoptysis (coughing up blood) (+1.0 point)
Malignancy (on treatment, treated within the last 6 months, or palliative) (+1.0 point)
PE Clinical Stratification & Management
Traditional 3-Tier Model:
Score 0–1: Low Probability (Utilize PERC rule / D-dimer to rule out).
Score 2–6: Moderate Probability (High-sensitivity D-dimer or CTA).
Score 7 or more: High Probability (Proceed directly to CT Pulmonary Angiography / CTA).
Simplified 2-Tier Model:
Score 4 or less: PE Unlikely (Order high-sensitivity D-dimer; if negative, PE is ruled out).
Score greater than 4: PE Likely (Proceed directly to diagnostic imaging like CT Pulmonary Angiography).
Wells Criteria References
Wells, P. S., Anderson, D. R., Bormanis, J., et al. (1997). Value of assessment of pretest probability of deep-vein thrombosis in clinical management. The Lancet, 350(9094), 1795-1798.
Wells, P. S., Anderson, D. R., Rodger, M., et al. (2000). Derivation of a simple clinical model to catergorize patients probability of pulmonary embolism: application to receive operating characteristic curves. Thrombosis and Haemostasis, 83(03), 416-420.
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