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Wells Clinical Prediction Rule for Pulmonary Embolism and Deep Venous Thrombosis

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 edema

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%).

Related Criteria:

NYHA Functional Classification for Congestive Heart Failure

Framingham Criteria for Congestive Heart Failure

Cardiovascular Major Risk Factors

Duke Criteria for Infective Endocarditis (IE)

Revised Jones Criteria for Acute Rheumatic Fever (ARF)

Braunwald Classification of Unstable Angina (UA)

Diagnostic Criteria for Thromboangiitis Obliterans (Buerger’s Disease)

More...

References:

  1. 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]

  2. 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]

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Created: April 13, 2006
Last Modified: 10/17/2010

 
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