Wells et al developed a simple clinical model for identifying a patient who may have a pulmonary embolus (PE). The authors are from the University of Ottawa, McMaster University and Dalhousie University in Canada.
Parameters:
(1) clinical signs and symptoms of deep vein thrombosis
(2) alternative diagnosis
(3) heart rate (tachycardia)
(4) surgery or immobilization within past month
(5) history of deep vein thrombosis and/or pulmonary embolus
(6) hemoptysis
(7) history of malignant neoplasm
|
Parameter |
Finding |
Points |
|
clinical signs/symptoms DVT |
absent |
0 |
|
|
present |
3 |
|
alternative diagnosis |
likely |
0 |
|
|
unlikely |
3 |
|
heart rate |
<= 100 beats per minute |
0 |
|
|
> 100 beats per minute |
1.5 |
|
surgery or immobilization |
absent |
0 |
|
|
present |
1.5 |
|
history of DVT or PE |
absent |
0 |
|
|
present |
1.5 |
|
hemoptysis |
absent |
0 |
|
|
present |
1 |
|
malignant neoplasm |
absent |
0 |
|
|
present |
1 |
where:
• Signs and symptoms of deep vein thrombosis include leg swelling and pain on deep venous palpation.
• The presence of an alternative diagnosis would seem worthy of negative points.
• The malignant neoplasm should be significant and have a residual effect. Ideally it should be one associated with a hypercoagulable state.
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12.5
• The higher the score the greater the risk of a pulmonary embolism.
• A score <= 4 indicates that a PE is unlikely, while a score > 4 indicates that one is likely.
Specialty: Pulmonology
ICD-10: ,
