Pneumologie
Wells Score for Pulmonary Embolism
Probabilité pré-test d’embolie pulmonaire.
Contenu en anglais
Calculateur Score de Wells (EP)
Résultat
0.0points
Faible (~1.3%) — D-dimères d’abord
Comment l’utiliser
- 1
Rechercher des signes de TVP. Œdème du membre, érythème, douleur sur le trajet veineux profond = 3 points.
- 2
L’EP est-elle le diagnostic le plus probable ?. Après analyse de l’ECG, de la radiographie thoracique et de la biologie, si l’EP est en tête du diagnostic différentiel = 3 points.
- 3
Appliquer l’algorithme. Faible + D-dimères négatifs = exclue. Modérée + D-dimères négatifs = exclue. Élevée = angioscanner d’emblée.
Quand l’utiliser
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.
- Suspicion d’EP, hémodynamique stable
- Outil de tri standard aux urgences et en unité de médecine aiguë.
- Avec la règle PERC
- Si tous les critères PERC sont absents chez un patient réellement à faible probabilité, ne pas doser les D-dimères.
- Pas pour l’EP massive
- Instabilité hémodynamique → angioscanner ou échocardiographie au lit immédiatement.
À propos du score
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.
Questions fréquentes
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.
