Sunday, March 4, 2012

Well's Criteria for Pulmonary Embolism

Well's Criteria for Pulmonary Embolism
UseEstimates likelihood of pulmonary embolism
Scoringclinically suspected DVT (+3 points)
alternative diagnosis is less likely than PE (+3 points)
tachycardia (+1.5 points)
immobilization/surgery in previous four weeks (+1.5 points)
history of DVT or PE (+1.5 points)
hemoptysis (+1 point)
malignancy (treatment for within 6 months, palliative) (+1 point)
Assessment  Traditional interpretation:
  *  > 6 - High (59% probability)
  * 2 to 6 - Moderate (29% probability)
  * < 2 - Low (15% probability)

Alternative interpretation (used in CGH)
  * > 4 - PE likely. Consider diagnostic imaging. Repeat if scan within 1 week if strong suspicion
  * 4 or less - PE unlikely. Consider D-dimer
Follow up investigations
(+) D-dimer(-) D-dimer
Low pretest probability scoreUrgent scan
If (-), discharge
< 1% risk of DVT.
No scan
.Pulmonary embolism

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