Wells Score for Pulmonary Embolism (PE)
Clinical pretest probability tool for suspected pulmonary embolism.
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Haftungsausschluss: Nur zu Bildungszwecken. Kein Ersatz für klinisches Urteil. Use with validated diagnostic pathways (e.g., Wells + D-dimer + imaging, PERC where appropriate).
Über dieses Tool
What Is the Wells Score for PE?
The Wells score for pulmonary embolism (PE) is a validated clinical decision rule that estimates pretest probability of PE based on clinical signs and risk factors. Published by Wells et al. in 2000–2001, it assigns weighted points to seven criteria and stratifies patients into probability tiers that guide subsequent diagnostic testing — particularly whether D-dimer testing can safely exclude PE or whether imaging (CTPA) is required.
When to Use the Wells PE Score
Apply the Wells PE score in emergency department or ward patients presenting with symptoms suggestive of PE (dyspnea, pleuritic chest pain, hemoptysis, tachycardia) where PE is in the differential. It should be used as part of a validated diagnostic algorithm — typically Wells score → D-dimer (if low probability) → CTPA (if high probability or positive D-dimer). In very low-risk patients, consider applying PERC criteria first before D-dimer testing.
Interpreting Wells PE Results
The two-tier interpretation (≤4 = PE unlikely, >4 = PE likely) is most commonly used in practice. In the "unlikely" group, a negative high-sensitivity D-dimer effectively excludes PE (NPV >99%). In the "likely" group, proceed directly to CTPA. The three-tier version (low <2, moderate 2–6, high >6) provides finer granularity but is less commonly used in current algorithms.
🔑 Klinische Hinweise
- "PE is the most likely diagnosis" (+3 points) is the most subjective criterion and has the highest weight. It should reflect overall clinical gestalt after considering the full differential.
- Age-adjusted D-dimer cutoffs (age × 10 µg/L for patients >50) can increase specificity without meaningfully reducing sensitivity.
- Wells is less reliable in hospitalized patients, pregnant women, and cancer patients — consider alternative approaches (e.g., YEARS algorithm).
- A normal Wells score does not exclude PE — it estimates probability. Always integrate with clinical judgment.
Schlüsselreferenzen
- Wells PS, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected PE using clinical assessment and D-dimer. Ann Intern Med. 2001;135(2):98–107.
- van Belle A, et al. Effectiveness of managing suspected PE using an algorithm combining clinical probability, D-dimer testing, and CTPA. JAMA. 2006;295(2):172–179.
- Raja AS, et al. Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice. Ann Intern Med. 2015;163(9):701–711.
Formel zuletzt überprüft: Februar 2026