What are the Wells criteria for pulmonary embolism?

Diagnosis  ·  April 8, 2026

From the Guidelines

Wells Criteria for Pulmonary Embolism

The Wells criteria is a clinical prediction rule used to estimate the pretest probability of pulmonary embolism (PE) in patients with suspected PE [1][2]. According to available evidence, the Wells criteria helps categorize patients into different risk categories to guide further diagnostic testing.

Clinical Probability Categories

The Wells criteria classifies patients into probability categories based on their clinical presentation [1]:

Modified Wells Score Categories

The sources reference a modified Wells score (mWS) that uses a simplified scoring system [5]:

Clinical Application

Diagnostic Strategy

According to available evidence, the Wells criteria serves as an adjunct to clinical gestalt in estimating PE probability [1]. The criteria is used alongside other clinical prediction rules such as:

Integration with D-dimer Testing

The Wells criteria is commonly used in combination with D-dimer testing [2][5]:

Performance Characteristics

Based on the available studies:

Limitations

The sources indicate that current clinical predictors including Wells criteria have predominantly focused on outpatient and emergency department populations [4], and no clinical prediction models have been validated in pregnancy [3].

Note: The specific individual components and point values of the Wells criteria are not detailed in the provided sources.

Sources

[1]
Diagnostic Strategies in Pulmonary Embolism. — Int J Angiol, 2024
[2]
Venous Thromboembolism: Diagnosis and Treatment. — Am Fam Physician, 2025
[3]
The utility of the Wells clinical prediction model and ventilation-perfusion scanning for pulmonary embolism diagnosis in pregnancy. — Blood Coagul Fibrinolysis, 2014
[4]
Clinical predictors of pulmonary embolism for inpatients: are computed tomography pulmonary angiograms being requested appropriately? — Intern Med J, 2023
[5]
Diagnostic approach and use of CTPA in patients with suspected pulmonary embolism in an emergency department in Saudi Arabia. — Blood Res, 2023

Frequently Asked Questions

How is the Wells criteria used with D-dimer testing for pulmonary embolism?

The Wells criteria is combined with D-dimer testing to rule out PE based on risk stratification: low and moderate-risk patients can use D-dimer testing for exclusion, while high-probability patients should proceed directly to chest imaging without D-dimer testing due to reduced negative predictive value.

What is the difference between Wells criteria and modified Wells score for PE?

The Wells criteria classifies patients into three probability categories (low <15%, moderate 15-40%, high >40%), while the modified Wells score uses a simplified scoring system with a cutoff of ≤4 for PE unlikely and >4 for PE likely.

What is the sensitivity and negative predictive value of Wells criteria for pulmonary embolism?

The Wells criteria has a negative predictive value of 95.8% and demonstrated 100% sensitivity when combined with negative D-dimer testing for avoiding unnecessary imaging in PE evaluation.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Mentor MD assumes no liability for clinical decisions based on this content.