Neumología
Wells Score for Pulmonary Embolism
Probabilidad pretest de tromboembolismo pulmonar.
Contenido en inglés
Calculadora Escala de Wells (TEP)
Resultado
0.0puntos
Baja (~1.3%) — dímero D primero
Cómo usarla
- 1
Buscar signos de TVP. Hinchazón de la pierna, eritema, dolor a lo largo de las venas profundas = 3 puntos.
- 2
¿Es el TEP el diagnóstico más probable?. Tras revisar ECG, radiografía de tórax y analítica, si el TEP encabeza el diagnóstico diferencial = 3 puntos.
- 3
Aplicar el algoritmo. Baja + dímero D negativo = descartado. Moderada + dímero D negativo = descartado. Alta = angio-TC pulmonar directamente.
Cuándo usarla
Apply to any patient presenting with acute dyspnoea, pleuritic chest pain, tachycardia, or other features suggesting PE. Use before ordering CT-PA or D-dimer to determine the appropriate diagnostic pathway. Do not apply after CT-PA has already been ordered without consideration of pre-test probability.
- Sospecha de TEP, hemodinámicamente estable
- Herramienta de triaje estándar en urgencias y unidades de agudos.
- Con la regla PERC
- Si faltan todos los criterios PERC en una probabilidad realmente baja, no solicitar el dímero D.
- No para el TEP masivo
- Inestabilidad hemodinámica → angio-TC o ecocardiografía a pie de cama de inmediato.
Sobre la escala
The Wells score for pulmonary embolism (PE) is the most widely used and validated clinical prediction rule for estimating pre-test probability of PE in patients presenting with suspected thromboembolic disease. It combines seven clinical variables — including clinical signs of DVT, heart rate, recent immobilisation or surgery, prior PE or DVT, haemoptysis, malignancy, and clinical judgement — to stratify patients into low, intermediate, or high probability groups. This stratification directly guides the diagnostic pathway: whether to proceed to CT pulmonary angiography (CT-PA) immediately, or to first perform D-dimer testing to safely rule out PE in low-risk patients.
Preguntas frecuentes
What Wells score rules out PE?
A Wells PE score of ≤1 (low probability) combined with a negative D-dimer (conventional or age-adjusted threshold) safely excludes PE without CT-PA in the majority of patients. This approach has a miss rate of <1% in large validation studies.
What is the difference between Wells PE and Wells DVT?
Wells PE estimates the probability of pulmonary embolism, while Wells DVT estimates the probability of deep vein thrombosis in the lower limbs. They share some overlapping variables (DVT history) but are distinct scores applied in different clinical presentations.
