{"id":28891,"date":"2022-06-22T10:15:38","date_gmt":"2022-06-22T08:15:38","guid":{"rendered":"https:\/\/www.inanutshell.ch\/?page_id=28891"},"modified":"2022-06-22T10:15:38","modified_gmt":"2022-06-22T08:15:38","slug":"wells-criteria-for-pulmonary-embolism","status":"publish","type":"page","link":"https:\/\/www.inanutshell.ch\/en\/digital-doctors-bag\/wells-criteria-for-pulmonary-embolism\/","title":{"rendered":"Wells\u2019 Criteria for Pulmonary Embolism"},"content":{"rendered":"<p>The Wells\u2019 Criteria for pulmonary embolism can be used to estimate the probability of pulmonary embolism based on the history and clinical criteria. This results in a recommendation for further diagnostics depending on the pretest probability.<\/p>\n    <div class=\"medical-calculator wells-lung-embolism\" id=\"medical-calculator-wells-lung-embolism\">\r\n        <form>\r\n            <div class=\"form-group row\">\r\n                <div class=\"col-sm-8 col-form-label\">\r\n                                    Clinical signs and symptoms of deep vein thrombosis<br \/>\r\n                    <span class=\"label-lighter\">(leg swelling or compressive tenderness along the deep veins)<\/span>\r\n                                <\/div>\r\n                <div class=\"col-sm-4 mt-sm-2\">\r\n                    <div class=\"d-flex btn-group btn-group-toggle\" data-toggle=\"buttons\">\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"deep-leg-vein-thrombosis\" id=\"medical-calculator-wells-lung-embolism-deep-leg-vein-thrombosis-n\" value=\"N\" tabindex=\"1\" autocomplete=\"off\">\r\n                                                        No\r\n                                                    <\/label>\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"deep-leg-vein-thrombosis\" id=\"medical-calculator-wells-lung-embolism-deep-leg-vein-thrombosis-y\" value=\"Y\" tabindex=\"2\" autocomplete=\"off\">\r\n                                                        Yes (+3)\r\n                                                    <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"form-group row\">\r\n                <div class=\"col-sm-8 col-form-label\">\r\n                                    Pulmonary embolism as likely or more likely than an alternative diagnosis\r\n                                <\/div>\r\n                <div class=\"col-sm-4 mt-sm-2\">\r\n                    <div class=\"d-flex btn-group btn-group-toggle\" data-toggle=\"buttons\">\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"alt-diagnosis-likely\" id=\"medical-calculator-wells-lung-embolism-alt-diagnosis-likely-n\" value=\"N\" tabindex=\"3\" autocomplete=\"off\">\r\n                                                        No\r\n                                                    <\/label>\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"alt-diagnosis-likely\" id=\"medical-calculator-wells-lung-embolism-alt-diagnosis-likely-y\" value=\"Y\" tabindex=\"4\" autocomplete=\"off\">\r\n                                                        Yes (+3)\r\n                                                    <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"form-group row\">\r\n                <div class=\"col-sm-8 col-form-label mt-auto\">\r\n                                    Hearth rate &gt; 100 bpm\r\n                                <\/div>\r\n                <div class=\"col-sm-4\">\r\n                    <div class=\"d-flex btn-group btn-group-toggle\" data-toggle=\"buttons\">\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"heart-freq-gt100\" id=\"medical-calculator-wells-lung-embolism-heart-freq-gt100-n\" value=\"N\" tabindex=\"5\" autocomplete=\"off\">\r\n                                                        No\r\n                                                    <\/label>\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"heart-freq-gt100\" id=\"medical-calculator-wells-lung-embolism-heart-freq-gt100-y\" value=\"Y\" tabindex=\"6\" autocomplete=\"off\">\r\n                                                        Yes (+1.5)\r\n                                                    <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"form-group row\">\r\n                <div class=\"col-sm-8 col-form-label\">\r\n                                    Immobilization (&ge; 3 days) or surgery in the past 4 weeks\r\n                                <\/div>\r\n                <div class=\"col-sm-4 mt-sm-2\">\r\n                    <div class=\"d-flex btn-group btn-group-toggle\" data-toggle=\"buttons\">\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"immobilisation-operation-4w\" id=\"medical-calculator-wells-lung-embolism-immobilisation-operation-4w-n\" value=\"N\" tabindex=\"7\" autocomplete=\"off\">\r\n                                                        No\r\n                                                    <\/label>\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"immobilisation-operation-4w\" id=\"medical-calculator-wells-lung-embolism-immobilisation-operation-4w-y\" value=\"Y\" tabindex=\"8\" autocomplete=\"off\">\r\n                                                        Yes (+1.5)\r\n                                                    <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"form-group row\">\r\n                <div class=\"col-sm-8 col-form-label mt-auto\">\r\n                                    Previously diagnosed deep vein thrombosis or pulmonary embolism\r\n                                <\/div>\r\n                <div class=\"col-sm-4\">\r\n                    <div class=\"d-flex btn-group btn-group-toggle\" data-toggle=\"buttons\">\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"leg-vein-lung-embolism\" id=\"medical-calculator-wells-lung-embolism-leg-vein-lung-embolism-n\" value=\"N\" tabindex=\"9\" autocomplete=\"off\">\r\n                                                        No\r\n                                                    <\/label>\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"leg-vein-lung-embolism\" id=\"medical-calculator-wells-lung-embolism-leg-vein-lung-embolism-y\" value=\"Y\" tabindex=\"10\" autocomplete=\"off\">\r\n                                                        Yes (+1.5)\r\n                                                    <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"form-group row\">\r\n                <div class=\"col-sm-8 col-form-label mt-auto\">\r\n                                    Hemoptysis\r\n                                <\/div>\r\n                <div class=\"col-sm-4\">\r\n                    <div class=\"d-flex btn-group btn-group-toggle\" data-toggle=\"buttons\">\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"haemoptysis\" id=\"medical-calculator-wells-lung-embolism-haemoptysis-n\" value=\"N\" tabindex=\"11\" autocomplete=\"off\">\r\n                                                        No\r\n                                                    <\/label>\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"haemoptysis\" id=\"medical-calculator-wells-lung-embolism-haemoptysis-y\" value=\"Y\" tabindex=\"12\" autocomplete=\"off\">\r\n                                                        Yes (+1)\r\n                                                    <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"form-group row\">\r\n                <div class=\"col-sm-8 col-form-label\">\r\n                                    Malignancy<br \/>\r\n                    <span class=\"label-lighter\">(existing therapy, palliative therapy, or treatment discontinuation within the last 6 months)<\/span>\r\n                                <\/div>\r\n                <div class=\"col-sm-4 mt-sm-2\">\r\n                    <div class=\"d-flex btn-group btn-group-toggle\" data-toggle=\"buttons\">\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"malignoma-6mon\" id=\"medical-calculator-wells-malignoma-6mon-n\" value=\"N\" tabindex=\"13\" autocomplete=\"off\">\r\n                                                        No\r\n                                                    <\/label>\r\n                        <label class=\"btn btn-outline-secondary\">\r\n                            <input type=\"radio\" name=\"malignoma-6mon\" id=\"medical-calculator-wells-malignoma-6mon-y\" value=\"Y\" tabindex=\"14\" autocomplete=\"off\">\r\n                                                        Yes (+1)\r\n                                                    <\/label>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n        <\/form>\r\n        <div class=\"row\">\r\n            <div class=\"col-sm-12\">\r\n                <div id=\"medical-calculator-wells-lung-embolism-result-text\" class=\"result-text\">\r\n                    <p><h5>                    Wells\u2019 Criteria for Pulmonary Embolism:\r\n                                        <span id=\"medical-calculator-wells-lung-embolism-result-value\"><\/span><\/h5><\/p>\r\n                    <p>\r\n                        <a href=\"#wells-lung-embolism-cite-note-2\">\r\n                                                Classification according van Belle et al.\r\n                        <\/a> [2]\r\n                    <\/p>\r\n                    <p id=\"medical-calculator-wells-lung-embolism-result-interpretation\"><\/p>\r\n                    <p>                        Recommendation:\r\n                                        <span id=\"medical-calculator-wells-lung-embolism-result-recommendation\"><\/span>\r\n                    <\/p>\r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n\r\n        <div class=\"row\">\r\n            <div class=\"col-sm-12 mt-3\">\r\n                <h5>\r\n                                            Interpretation\r\n                                    <\/h5>\r\n                <div class=\"table-responsive-sm\">\r\n                    <table class=\"table table-bordered\">\r\n                        <thead>\r\n                            <tr>\r\n                                <th>\r\n                                                                            Score\r\n                                                                    <\/th>\r\n                                <th>\r\n                                                                            Original classification according to Wells et al. <a href=\"#wells-lung-embolism-cite-note-1\">[1]<\/a>\r\n                                                                    <\/th>\r\n                                <th>\r\n                                                                            Classification according to van Belle et al. <a href=\"#wells-lung-embolism-cite-note-2\">[2]<\/a>\r\n                                                                    <\/th>\r\n                            <\/tr>\r\n                        <\/thead>\r\n                        <tbody>\r\n                            <tr class=\"table-row-a\">\r\n                                <td>\r\n                                                                            &le; 1\r\n                                                                        \r\n                                <\/td>\r\n                                <td>\r\n                                                                            <p><strong>Low probability of pulmonary embolism<\/strong><\/p>\r\n                                        <p>Prevalence: 1.2 %<\/p>\r\n                                        <p>Recommandation: perform D-dimer test<\/p>\r\n                                        <p>\r\n                                            <ul>\r\n                                                <li>D-dimer negative: pulmonary embolism excluded<\/li>\r\n                                                <li>D-dimer positive: imaging to rule out pulmonary embolism<\/li>\r\n                                            <\/ul>\r\n                                        <\/p>\r\n                                                                    <\/td>\r\n                                <td rowspan=\"4\">\r\n                                                                            <p><strong>Pulmonary embolism unlikely<\/strong><\/p>\r\n                                        <p>Prevalence: 12.1 %<\/p>\r\n                                        <p>Recommendation: perform D-dimer test<\/p>\r\n                                        <p>\r\n                                            <ul>\r\n                                                <li>If D-dimer is negative, pulmonary embolism can be excluded.<\/li>\r\n                                                <li>If D-dimer is positive, CT angiography should be performed to rule out pulmonary embolism.<\/li>\r\n                                            <\/ul>\r\n                                        <\/p>\r\n                                                                    <\/td>\r\n                            <\/tr>\r\n                            <tr class=\"table-row-b\">\r\n                                <td>\r\n                                                                            2\r\n                                                                        \r\n                                <\/td>\r\n                                <td rowspan=\"5\">\r\n                                                                            <p><strong>Moderate probability of pulmonary embolism<\/strong><\/p>\r\n                                        <p>Prevalence: 16.2 %<\/p>\r\n                                        <p>Recommendation: imaging to rule out pulmonary embolism<\/p>\r\n                                                                    <\/td>\r\n                            <\/tr>\r\n                            <tr class=\"table-row-c\">\r\n                                <td>\r\n                                                                            3\r\n                                                                        \r\n                                <\/td>\r\n                            <\/tr>\r\n                            <tr class=\"table-row-d\">\r\n                                <td>\r\n                                                                            4\r\n                                                                        \r\n                                <\/td>\r\n                            <\/tr>\r\n                            <tr class=\"table-row-e\">\r\n                                <td>\r\n                                                                            5\r\n                                                                        \r\n                                <\/td>\r\n                                <td rowspan=\"3\">\r\n                                                                            <p><strong>Pulmonary embolism likely<\/strong><\/p>\r\n                                        <p>Prevalence: 37.1 %<\/p>\r\n                                        <p>Recommendation: CT angiography should be performed to rule out pulmonary embolism.<\/p>\r\n                                                                    <\/td>\r\n                            <\/tr>\r\n                            <tr class=\"table-row-f\">\r\n                                <td>\r\n                                                                            6\r\n                                                                        \r\n                                <\/td>\r\n                            <\/tr>\r\n                            <tr class=\"table-row-g\">\r\n                                <td>\r\n                                                                            &ge; 7\r\n                                                                        \r\n                                <\/td>\r\n                                <td>\r\n                                                                            <p><strong>High probability of pulmonary embolism<\/strong><\/p>\r\n                                        <p>Prevalence: 37.5 %<\/p>\r\n                                        <p>Recommendation: imaging to rule out pulmonary embolism<\/p>\r\n                                                                    <\/td>\r\n                            <\/tr>\r\n                        <\/tbody>\r\n                    <\/table>\r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n\r\n        <div class=\"row\">\r\n            <div class=\"col-sm-12 mt-3\">\r\n                <h5>\r\n                                            References\r\n                                    <\/h5>\r\n                <ol class=\"references\">\r\n                    <li id=\"wells-lung-embolism-cite-note-1\">Wells PS, Anderson DR, Rodger M et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med 2001; 135: 98-107<\/li>\r\n                    <li id=\"wells-lung-embolism-cite-note-2\">van Belle A, B\u00fcller HR, Huisman MV et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006; 295: 172-179<\/li>\r\n                <\/ol>\r\n            <\/div>\r\n        <\/div>\r\n    <\/div>\r\n    <script type=\"text\/javascript\">\r\n                var medical_calculator_wells_lung_embolism_messages = {\r\n            'interpretation_le4' : 'Pulmonary embolism unlikely (Prevalence: 12.1 %)',\r\n            'interpretation_ge5' : 'Pulmonary embolism likely (Prevalence: 37.1 %)',\r\n            'recommendation_le4' : 'perform D-dimer test<br \/><p><ul><li>If D-dimer is negative, pulmonary embolism can be excluded.<\/li><li>If D-dimer is positive, CT angiography should be performed to rule out pulmonary embolism.<\/li><\/ul><\/p>',\r\n            'recommendation_ge5' : 'CT angiography should be performed to rule out pulmonary embolism.',\r\n            'point' : 'point',\r\n            'points' : 'points'\r\n        };\r\n            <\/script>\r\n\n","protected":false},"excerpt":{"rendered":"<p>The Wells\u2019 Criteria for pulmonary embolism can be used to estimate the probability of pulmonary embolism based on the history and clinical criteria. This results in a recommendation for further diagnostics depending on the pretest probability.<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":28833,"menu_order":117,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-28891","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/pages\/28891","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/comments?post=28891"}],"version-history":[{"count":1,"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/pages\/28891\/revisions"}],"predecessor-version":[{"id":28892,"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/pages\/28891\/revisions\/28892"}],"up":[{"embeddable":true,"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/pages\/28833"}],"wp:attachment":[{"href":"https:\/\/www.inanutshell.ch\/en\/wp-json\/wp\/v2\/media?parent=28891"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}