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Wells Score for Pulmonary Embolism

Pre-test probability of pulmonary embolism.

For healthcare professionalsThrombosis & VTEv1.0.0

For healthcare professionals / clinical use. Not a self-diagnosis tool.

Your measurements

Clinical signs and symptoms of DVT
PE is the most likely diagnosis
Heart rate over 100
Immobilisation ≥ 3 days or surgery in the past 4 weeks
Previous DVT or PE
Haemoptysis
Malignancy (treatment within 6 months or palliative)

Calculated on your device. Nothing is sent to a server.

Your result will appear here

Enter your measurements, then press Calculate.

Methodology

Wells PE (Wells 2000)

DVT signs 3, PE most likely 3, HR > 100 1.5, immobilisation/surgery 1.5, previous VTE 1.5, haemoptysis 1, malignancy 1

The two-level model is used with D-dimer testing in diagnostic pathways (ESC 2019). Three-level: < 2 low, 2–6 moderate, > 6 high.

Who it is for
Adults with suspected pulmonary embolism.
Version
1.0.0

How this calculator works

Where the formula comes from

  • Wells and colleagues (2000) used logistic regression on 40 clinical variables in a random 80% of patients from a prospective cohort with suspected pulmonary embolism, and validated the rule in the remaining 20%.[1]
  • The rule has seven items: clinical symptoms of DVT 3, no alternative diagnosis more likely than PE 3, heart rate over 100 1.5, immobilisation or surgery in the previous four weeks 1.5, previous DVT/PE 1.5, haemoptysis 1 and malignancy 1.[1]

The inputs

  • Two ways of reading the score were defined: three levels (under 2 low, 2–6 moderate, over 6 high) and two levels (4 or less PE unlikely, over 4 PE likely).[1]
  • In the derivation study, 7.8% of patients scoring 4 or less had PE, and 2.2% of those who also had a negative D-dimer.[1]

Versions and alternatives

  • The two-level rule combined with D-dimer testing and CT was evaluated in a large management study (Christopher study, 2006).[2]
  • A simplified Wells score giving one point per item was evaluated in 2008, and its diagnostic performance was compared with that of the original score.[3]
  • The revised Geneva score is an alternative prediction rule that does not include a subjective item.[4]

Where accuracy falls (published evidence)

  • In a 2007 reliability study, agreement between emergency physicians was only moderate for 'PE more likely than another diagnosis' (kappa 0.50) and for DVT symptoms (0.54).[5]

What guidelines say

  • The 2019 ESC guideline recommends basing the diagnostic strategy on clinical probability assessed by clinical judgement or a validated prediction rule such as Wells or revised Geneva.[4]
  • ESC 2019 recommends D-dimer testing in patients with low or intermediate clinical probability, or PE unlikely, to reduce unnecessary imaging; D-dimer is not recommended in patients with high clinical probability.[4]

Sources

  1. Wells PS, Anderson DR, Rodger M, et al. 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;83(3):416–420. doi:10.1055/s-0037-1613830
  2. van Belle A, Büller HR, Huisman MV, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006;295(2):172–179. doi:10.1001/jama.295.2.172
  3. Gibson NS, Sohne M, Kruip MJ, et al. Further validation and simplification of the Wells clinical decision rule in pulmonary embolism. Thromb Haemost. 2008;99(1):229–234. doi:10.1160/TH07-05-0321
  4. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543–603. doi:10.1093/eurheartj/ehz405
  5. Nordenholz KE, Naviaux NW, Stegelmeier K, et al. Pulmonary embolism risk assessment screening tools: the interrater reliability of their criteria. Am J Emerg Med. 2007;25(3):285–290. doi:10.1016/j.ajem.2006.08.016

Compiled from the published sources above. Every statement was agreed independently by three AI research tools (Claude, ChatGPT, DeepSeek) and its source verified in PubMed or Crossref by the Hakeemly editorial team. Not reviewed by a doctor unless stated. Agreed on

Worked example: how to calculate wells PE

Inputs

Clinical signs and symptoms of DVT
Yes
PE is the most likely diagnosis
Yes
Heart rate over 100
No
Immobilisation ≥ 3 days or surgery in the past 4 weeks
No
Previous DVT or PE
No
Haemoptysis
No
Malignancy (treatment within 6 months or palliative)
No

Result

Wells PE score
6

Over 4: PE likely (two-level model)

An illustration with sample values, worked out with the same method the tool above uses.

Limitations

  • Includes a subjective item ('PE most likely').

References

  1. Wells PS, Anderson DR, Rodger M, et al. 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;83(3):416–420.
  2. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2020;41(4):543–603. doi:10.1093/eurheartj/ehz405

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