Wells criteria to rule out Pulmonary Embolism
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In this video, we have
In this video, we have explained the wells (Dr. Phil Wells) criteria to diagnose patients with #pulmonary #embolism and #dvt.
The Wells criteria for pulmonary embolism is a risk stratification score and clinical decision rule used to predict the likelihood of acute pulmonary embolism in individuals whose medical history and physical examination indicate that acute PE is a diagnosis possibility. It provides a pre-test likelihood that can be utilized in conjunction with a negative D-dimer to rule out PE and avoid imagining.
Here’s a model to diagnose PE based on Well’s criteria.
But, remember,
The model should be applied only after a history and physical suggest that venous thromboembolism is a diagnostic possibility. It should not be applied to all patients with chest pain or dyspnea or to all patients with leg pain or swelling. This is the most common mistake made. Also, never ever do the D-dimer first [before the history and physical exam]. The monster in the box is that the D-dimer is done first and is positive (as it is for many patients with non-conditions) and then the physician assumes that venous thromboembolism is now possible and then the model is done. Do the history and physical exam first and decide if venous thromboembolism is a diagnostic possibility.
First,
In this case, we need to look for the clinical signs and symptoms of DVT, which include swelling in the affected leg. Rarely, there's swelling in both legs. The pain often starts in your calf and can feel like cramping or soreness. There could be red or discolored skin on the leg, and there could be a feeling of warmth in the affected leg.
If any two of the above signs are present, we need to score it as "yes," which will count for 3+.
Now, the next question is quite tricky, and you need to know, what exactly a patient with PE looks like. PE has a wide variety of presenting features, ranging from no symptoms to shock or sudden death. The most common presenting symptom is dyspnea, followed by chest pain (classically pleuritic but often dull pain) and cough. Typically, pain gets worsened with breathing and, in severe cases, there may be hemoptysis, syncope, and cynosis.
Based on this data derived from patients, you need to answer the following question.
Is PE the #1 diagnosis or equally likely?
If the answer is yes, it will receive a score of 3+ once more.
Next is the heart rate. If a patient has a heart rate of more than 100, then yes, it will score more than 1.5+.
Next, immobilization for at least 3 days OR surgery in the previous 4 weeks will score 1.5+, as the development of DVT is more common during this period and is one of the high risk factors after surgery.
Next, look for a history of the patient.
Previous, objectively diagnosed PE or DVT, can score 1+.
Next the history of hemoptysis score as 1+ and,
The last variable is whether the patient has malignancy with or without treatment within 6 months, or if palliative care also scores as 1+.
On a scale of 1 to 12.5, above 6.5 is high risk, between 3 and 6.5 it is moderate, and below 3 it is low risk of being diagnosed with pulmonary embolism.
The Wells criteria for pulmonary embolism is a risk stratification score and clinical decision rule used to predict the likelihood of acute pulmonary embolism in individuals whose medical history and physical examination indicate that acute PE is a diagnosis possibility. It provides a pre-test likelihood that can be utilized in conjunction with a negative D-dimer to rule out PE and avoid imagining.
Here’s a model to diagnose PE based on Well’s criteria.
But, remember,
The model should be applied only after a history and physical suggest that venous thromboembolism is a diagnostic possibility. It should not be applied to all patients with chest pain or dyspnea or to all patients with leg pain or swelling. This is the most common mistake made. Also, never ever do the D-dimer first [before the history and physical exam]. The monster in the box is that the D-dimer is done first and is positive (as it is for many patients with non-conditions) and then the physician assumes that venous thromboembolism is now possible and then the model is done. Do the history and physical exam first and decide if venous thromboembolism is a diagnostic possibility.
First,
In this case, we need to look for the clinical signs and symptoms of DVT, which include swelling in the affected leg. Rarely, there's swelling in both legs. The pain often starts in your calf and can feel like cramping or soreness. There could be red or discolored skin on the leg, and there could be a feeling of warmth in the affected leg.
If any two of the above signs are present, we need to score it as "yes," which will count for 3+.
Now, the next question is quite tricky, and you need to know, what exactly a patient with PE looks like. PE has a wide variety of presenting features, ranging from no symptoms to shock or sudden death. The most common presenting symptom is dyspnea, followed by chest pain (classically pleuritic but often dull pain) and cough. Typically, pain gets worsened with breathing and, in severe cases, there may be hemoptysis, syncope, and cynosis.
Based on this data derived from patients, you need to answer the following question.
Is PE the #1 diagnosis or equally likely?
If the answer is yes, it will receive a score of 3+ once more.
Next is the heart rate. If a patient has a heart rate of more than 100, then yes, it will score more than 1.5+.
Next, immobilization for at least 3 days OR surgery in the previous 4 weeks will score 1.5+, as the development of DVT is more common during this period and is one of the high risk factors after surgery.
Next, look for a history of the patient.
Previous, objectively diagnosed PE or DVT, can score 1+.
Next the history of hemoptysis score as 1+ and,
The last variable is whether the patient has malignancy with or without treatment within 6 months, or if palliative care also scores as 1+.
On a scale of 1 to 12.5, above 6.5 is high risk, between 3 and 6.5 it is moderate, and below 3 it is low risk of being diagnosed with pulmonary embolism.
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