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Wells criteria for pulmonary embolism — pre-test clinical probability of PE to guide D-dimer testing and imaging.
Clinical decision-support tool for qualified healthcare professionals. Results are not a diagnosis and should not replace professional clinical judgment.
Two-tier interpretation (most commonly used): ≤4 points = PE unlikely; >4 points = PE likely. In PE-unlikely patients a negative high-sensitivity D-dimer safely excludes PE. Three-tier interpretation: 0–1 low, 2–6 moderate, >6 high probability.
Specialty
Emergency MedicineCategory
EmergencyDifficulty
Basic
Estimated Time
30 seconds
Version
1.0
Last Updated
2026-08-15
Formula
Keywords
Normal Range
0–12.5 points
Estimates the pre-test probability of pulmonary embolism to guide D-dimer testing and imaging decisions.
The Wells PE score assigns 3 points each for clinical signs of DVT and for PE being the most likely diagnosis, 1.5 points each for heart rate over 100 bpm, immobilization/surgery, and prior DVT/PE, and 1 point each for hemoptysis and active malignancy. A two-tier interpretation treats a score above 4 as PE likely.
Leg swelling or pain on palpation suggesting DVT; Yes adds 3 points.
Clinical gestalt that PE is the most likely diagnosis; Yes adds 3 points.
Heart rate greater than 100 bpm; Yes adds 1.5 points.
Immobilization or recent surgery; Yes adds 1.5 points.
Prior documented DVT or PE; Yes adds 1.5 points.
Hemoptysis; Yes adds 1 point.
Active malignancy treated within 6 months or palliative; Yes adds 1 point.
Two-tier: score ≤4 = PE unlikely (negative high-sensitivity D-dimer safely excludes PE); score >4 = PE likely (proceed to CT pulmonary angiography). Three-tier: 0–1 low, 2–6 moderate, >6 high probability.
The Wells criteria enable risk-stratified testing for PE, reducing unnecessary CT angiography while maintaining diagnostic safety when paired with a high-sensitivity D-dimer.
A 40-year-old woman presents with palpitations and mild dyspnea, HR 118 bpm. She has no DVT signs, no immobilization, no prior VTE, and no malignancy; PE is not felt to be the most likely diagnosis.
Inputs:
Expected Result: Wells score 1.5 — PE unlikely. A negative high-sensitivity D-dimer safely excludes PE without imaging.
Two-tier: 4 or less = PE unlikely (D-dimer can rule out). More than 4 = PE likely (proceed to CT pulmonary angiography). Three-tier: 0-1 low, 2-6 moderate, more than 6 high probability.
Yes. The Wells score determines pre-test probability. If PE is unlikely (Wells 4 or less), age-adjusted D-dimer can further reduce unnecessary CT scans in patients over 50 years.
Wells was derived primarily in emergency department and outpatient settings. Performance differs in inpatients, where pre-test probability tools may overestimate risk. Clinical judgment is essential.
Disclaimer: This calculator is intended for educational and clinical decision support purposes only. The Wells PE score guides, but does not replace, D-dimer or CT pulmonary angiography and clinical judgment.