In patients with signs or symptoms of DVT and / or PE:1
In patients with a suspected DVT and / or PE:2
The two-level DVT Wells score is a clinical prediction rule for estimating the probability of DVT and an important step in the diagnostic pathway. Patients who score 2 points or more are likely to have DVT and those with 1 point or less are unlikely.3,4
The two-level PE Wells score is used for estimating the probability of a PE. Patients who score more than 4 points are likely to have a PE and those with 4 points or less are unlikely.4
The tables below show the two-level Wells scores.
|Active cancer (treatment ongoing, within 6 months, or palliative)||1|
|Paralysis, paresis or recent plaster immobilisation on the lower extremities||1|
|Recently bedridden for 3 days or more, or major surgery within 12 weeks requiring general or regional anaesthesia||1|
|Localised tenderness along the distribution of the deep venous system||1|
|Entire leg swollen||1|
|Calf swelling at least 3 cm larger than asymptomatic side||1|
|Pitting oedema confirmed to the symptomatic leg||1|
|Collateral superficial veins (non-varicose)||1|
|Previously documented DVT||1|
|An alternative diagnosis is at least as likely as DVT||-2|
|Clinical signs and symptoms of DVT (minimum of leg swelling and pain with palpitation of the deep veins)||3|
|An alternative diagnosis is less likely than PE||3|
|Heart rate >100 beats per minute||1.5|
|Immobilisation for more than 3 days or surgery in the previous 4 weeks||1.5|
|Previous DVT / PE||1.5|
|Malignancy (on treatment, treated in the last 6 months, or palliative)||1|
Adapted from NICE CG144, 2012.4
Initial risk stratification for patients with acute PE is based on clinical symptoms and signs of haemodynamic instability, which indicate a high risk of early death.5 In patients with PE who present without haemodynamic instability, further risk stratification requires assessment of two prognostic criteria:5
PE can therefore be stratified into high-risk or non-high-risk levels of early (in-hospital or 30 day) death, determining the optimal diagnostic strategies and initial management.5
|Early mortality risk||Indicators of risk|
|Haemodynamic instability*||Clinical parameters of PE severity and / or comorbidity: PESI class III–V or sPESI≥1||RV dysfunction on TTE or CTPA||Elevated cardiac troponin levels|
|Low||–||+‡||One (or none) positive|
|Low||–||–||–||Assessment optional; if assessed, negative|
Adapted from Konstantinides S et al. Eur Heart J 2019.5
* One of the following clinical presentations: cardiac arrest, obstructive shock, or persistent hypotension.
† Haemodynamic instability, combined with PE confirmation on computed tomography pulmonary angiography (CTPA) and / or evidence of RV dysfunction on transthoracic echocardiogram (TTE), is sufficient to classify a patient into the high-risk PE category. In these cases, neither calculation of the Pulmonary Embolism Severity Index (PESI) nor measurement of troponins or other cardiac biomarkers is necessary.
‡ Signs of RV dysfunction on TTE (or CTPA) or elevated cardiac biomarker levels may be present, despite a calculated PESI of I–II or an sPESI of 0. Until the implications of such discrepancies for the management of PE are fully understood, these patients should be classified into the intermediate-risk category.