Expansion
Score first, then D-dimer or CT pulmonary angiogram
Expansion
Wells score for PE
- Clinical signs of DVT: 3
- PE is the most likely diagnosis: 3
- Heart rate over 100: 1.5
- Immobilisation over 3 days or surgery within 4 weeks: 1.5
- Previous DVT or PE: 1.5
- Haemoptysis: 1
- Malignancy treated within 6 months: 1
Interpretation
- Above 4: PE likely. Immediate CTPA, with interim anticoagulation if delayed
- 4 or less: PE unlikely. D-dimer; if negative, PE is excluded; if positive, CTPA
“The two 3 pointers are the clinical ones”, and they alone can make PE likely.
PERC rule may exclude PE without any test in a very low risk patient where all eight criteria are negative.
V/Q scan rather than CTPA in pregnancy, renal impairment and contrast allergy, particularly where the chest radiograph is normal.
ECG most often shows sinus tachycardia; the classic S1Q3T3 is uncommon and non-specific. Massive PE with haemodynamic instability is an indication for thrombolysis.