Wells Score Calculator for PE
Calculate the weighted Wells PE pretest-probability score with two-level and three-level classifications.
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Wells PE score
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A pretest-probability reference only; it does not diagnose or exclude pulmonary embolism.
About
The Wells PE score is a weighted pretest-probability rule for adults with suspected acute pulmonary embolism. It was derived for a clinical assessment rather than asymptomatic screening, and the seven selections are applied before the appropriate diagnostic pathway. The original derivation and bedside management work support a structured assessment, but the score cannot diagnose or exclude PE by itself. [1, 2]
This page calculates only the selected criteria and their validated point total. “PE more likely than an alternative diagnosis” is a clinician judgment; the calculator does not verify signs, history, records, vital signs, D-dimer, or imaging. A pretest label is not a confirmed-PE severity, mortality, disposition, or treatment score. The algorithm was studied in pathways that also require clinical examination and appropriate testing, including the management approach described by the Christopher study. [3, 4, 5]
Interpretation
| Model | Score range | Published label | What it means and does not mean |
|---|---|---|---|
| Modified two-level | ≤4.0 / >4.0 | PE unlikely / PE likely | A pretest-probability grouping used in some adult pathways; 4.0 is unlikely and 4.5 is likely. It is not exclusion, confirmation, or a treatment instruction. |
| Standard three-level | <2 / 2–6 / >6 | Low / Moderate / High pretest probability | A three-group model. Scores 2.0 and 6.0 are moderate; the label is model terminology, not an individual probability or diagnosis. |
Pretest probability groups the selected history and findings before D-dimer blood testing or imaging. “PE unlikely” does not mean PE has been ruled out, and “PE likely” does not mean PE has been confirmed. D-dimer and imaging decisions depend on the applicable adult pathway, assay, presentation, examination, and local resources; some suitable adults older than 50 use an FEU threshold of age × 10 µg/L, which this page does not apply. NICE two-level Wells guidance applies to adults, not pregnancy or people under 18. PERC and YEARS are separate rules, not alternate labels for this score. The page does not calculate PERC, YEARS, age-adjusted D-dimer, PESI/sPESI, or the 2026 AHA/ACC Acute PE Clinical Categories A–E. [4, 5, 6, 7, 8]
Wells PE criteria, model boundaries, and examples
Seven weighted criteria
The table below preserves the original seven-item wording and points. It describes what a submitted Yes means; it does not perform an examination or retrieve a history.
| Criterion | Points | Required interpretation | Important boundary |
|---|---|---|---|
| Clinical signs and symptoms of DVT | 3 | Leg swelling and pain with palpation of the deep veins. | Leg swelling and pain with palpation of the deep veins are the original clinical signs; this page does not verify an examination. |
| PE more likely than an alternative diagnosis | 3 | A subjective clinical judgment; it is not a laboratory or imaging finding. | This is a clinician judgment about the leading alternative, not a laboratory or imaging finding and not an automatic diagnosis. |
| Heart rate over 100 beats/min | 1.5 | A heart rate of exactly 100 does not score this item. | The threshold is strictly over 100 beats/min; exactly 100 receives zero points. |
| Immobilization or recent surgery | 1.5 | Immobilization for at least 3 days or surgery in the previous 4 weeks. | The original weighted model says immobilization for at least 3 days or surgery in the previous 4 weeks. NICE NG158 uses adapted wording of more than 3 days. |
| Previous DVT or PE | 1.5 | A documented prior venous thromboembolism history. | Use a documented previous venous thromboembolism history; the calculator does not retrieve a medical record. |
| Hemoptysis | 1 | Coughing blood. | The item is hemoptysis (coughing blood), not a general respiratory symptom. |
| Malignancy | 1 | Active, treated within the previous 6 months, or palliative. | The original definition includes active cancer, treatment within the previous 6 months, or palliative disease. |
The original derivation uses immobilization for at least 3 days. NICE NG158 uses adapted wording of more than 3 days; those phrases should not be silently mixed. [1, 6]
What this calculator actually does
It (1) reads seven explicit Yes/No selections, (2) validates that none is unassessed, (3) uses the frozen weighted implementation, and (4) reports the total with both published classification labels and a complete audit of all seven responses. It does not inspect records, auto-identify DVT, validate the heart rate, apply D-dimer or imaging rules, select CTPA or V/Q testing, choose anticoagulation, or grade a confirmed PE. It provides no treatment recommendation nor an imaging order.
Wells and other PE tools are not interchangeable
| Model | Intended stage | Inputs or purpose | Why it cannot be substituted here |
|---|---|---|---|
| Wells PE | Suspected adult acute PE | Seven weighted clinical criteria | This page computes only this model. |
| PERC | Selected very-low-suspicion adults | Eight different rule-out criteria | A low Wells score does not make every PERC item negative. [9] |
| D-dimer | Laboratory step in a pathway | Assay-specific fibrin degradation measurement | This page has no assay result or cutoff. Age-adjusted approaches are separate. [10] |
| YEARS | Suspected PE diagnostic algorithm | Three items plus its own D-dimer thresholds | Its items, thresholds, and validation are not the seven Wells criteria. [11] |
| Pregnancy-adapted YEARS | Pregnancy-specific diagnostic pathway | Pregnancy context, YEARS items, and D-dimer | It is not a general Wells calculation. [12] |
| PESI / sPESI | After PE is diagnosed | Prognostic severity and short-term risk variables | A confirmed-PE severity model cannot be derived from Wells. [4, 5, 8] |
| AHA/ACC 2026 categories | Confirmed acute PE | Post-diagnosis clinical severity framework | The 2026 AHA/ACC Acute PE Clinical Categories A–E apply after pulmonary embolism has been confirmed. They are not a pretest-probability score and are not calculated here. [4, 5, 7, 8] |
The 2026 AHA/ACC categories apply after pulmonary embolism has been confirmed and are not calculated by this Wells page. [4, 5]
Worked examples from the frozen implementation
- 0.0 points: all seven No responses produce PE unlikely and Low pretest probability. That label does not alone exclude PE.
- 4.0 points: DVT signs Yes (+3) and hemoptysis Yes (+1) produce PE unlikely and Moderate pretest probability.
- 4.5 points: DVT signs Yes (+3) and heart rate over 100 Yes (+1.5) produce PE likely and Moderate pretest probability.
These examples demonstrate arithmetic and boundary behavior, not patient-level probability, diagnosis, imaging, disposition, or treatment.
Limitations and special contexts
Children, pregnancy, recurrent PE, already-anticoagulated patients, inpatients, recent surgery, active cancer, confirmed PE, unstable presentations, and urgent or resuscitation settings may differ from the populations, timing, or pathways used to validate a Wells model. The arithmetic remains reproducible, but those contexts can change pretest assessment and the evidence supporting a pathway. Do not let a calculator delay urgent evaluation. NICE, ASH, ESC, and AHA/ACC guidance should be read in their full clinical context. [4, 5, 6, 7, 8]
References
- Wells PS, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism. Thromb Haemost. 2000;83(3):416-420. PMID 10744147.
- Wells PS, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging. Ann Intern Med. 2001;135(2):98-107. PMID 11453709.
- van Belle A, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm. Lancet. 2006;367:113-119. PMID 16413875.
- 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults. Circulation. PMID 41712677. DOI 10.1161/CIR.0000000000001415.
- Creager MA, Barnes GD, Giri J, et al. Correction to: 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults. Circulation. 2026;154(2):e24. PMID 42441758. DOI 10.1161/CIR.0000000000001462.
- NICE NG158. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing.
- American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv. 2018;2(22):3226-3256. PMID 30482764. DOI 10.1182/bloodadvances.2018024828.
- Konstantinides SV, et al. 2019 ESC Guidelines for acute pulmonary embolism. Eur Heart J. 2020;41:543-603. PMID 31473594.
- Kline JA, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6:772-780. PMID 18318689.
- Righini M, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: ADJUST-PE. JAMA. 2014;311:1117-1124. PMID 24686878. DOI 10.1001/jama.2014.2135.
- van der Hulle T, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study). Lancet. 2017;390:289-297. PMID 28549662. DOI 10.1016/S0140-6736(17)30885-1.
- van der Pol LM, et al. Pregnancy-Adapted YEARS Algorithm for Pulmonary Embolism. N Engl J Med. 2019;380:1139-1149. PMID 30893534. DOI 10.1056/NEJMoa1813865.
FAQ
Clinical DVT signs and PE more likely than an alternative diagnosis each add 3 points. Heart rate over 100, immobilization for at least 3 days or surgery in the prior 4 weeks, and previous DVT/PE each add 1.5. Hemoptysis and qualifying malignancy each add 1. The maximum is 12.5.
Sources: [1]
Guidelines use pretest probability before choosing an appropriate D-dimer or imaging pathway. A negative D-dimer is meaningful only in the applicable pretest-probability and assay context; an elevated D-dimer does not diagnose PE. This calculator does not execute a D-dimer pathway.
PERC is a separate eight-item rule for selected very-low-suspicion patients. A low Wells score does not automatically make a patient PERC negative, because every PERC item and the appropriate clinical context still need assessment.
Sources: [9]
YEARS is an independent diagnostic algorithm with three clinical items, including DVT signs, hemoptysis, and PE most likely. It uses its own D-dimer thresholds and cannot be substituted for, or inferred from, this full seven-item Wells calculation.
Sources: [11]
No. The original criterion is heart rate over 100 beats per minute. A value of exactly 100 does not add 1.5 points.
Sources: [1]
The weighted item is immobilization for at least 3 days or surgery in the preceding 4 weeks. Malignancy means active disease, treatment within the previous 6 months, or palliative disease. NICE NG158 uses adapted wording of more than 3 days, so the source-specific wording should not be silently mixed.
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Disclaimer
Educational and informational reference only. Not intended to replace professional medical advice, diagnosis, treatment, or independent verification.