Pulmonary Embolism Pretest Probability

Aka: Pulmonary Embolism Pretest Probability, Wells Clinical Prediction Rule for PE

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II. Criteria

  1. PE more likely than alternatives: 3.0 points
  2. Deep Vein Thrombosis (DVT) suspected: 3.0 points
  3. Tachycardia (pulse >100 beats per minute): 1.5 points
  4. Surgery or immobilization in last 4 weeks: 1.5 points
  5. Prior DVT or Pulmonary Embolism: 1.5 points
  6. Hemoptysis: 1.0 points
  7. Active malignancy: 1.0 points

III. Interpretation

  1. Score 0-2 points: Low PE Probability (3.6% risk)
    1. Positive Likelihood Ratio: 0.1
    2. Negative Likelihood Ratio: 7.6
  2. Score 3-6 points: Moderate PE Probability (20.5% risk)
    1. Positive Likelihood Ratio: 1.3
    2. Negative Likelihood Ratio: 0.7
  3. Score >6 points: High PE Probability (66.7% risk)
    1. Positive Likelihood Ratio: 6.8
    2. Negative Likelihood Ratio: 1.8

IV. Interpretation: Simplified

  1. Score 4 or less: Unlikely
  2. Score >4: Likely
  3. D-Dimer negative with "unlikely" score safely excludes Pulmonary Embolism

V. References

  1. Tamariz (2004) Am J Med 117(9): 676-84 [PubMed]
  2. Wells (2000) Thromb Haemost 83:416-20 [PubMed]
  3. Wells (2001) Ann Intern Med 135(2): 98-107 [PubMed]

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