🫁 Pulmonary Embolism Pathway (Wells-PE + D-dimer)
Work up suspected pulmonary embolism with the two-tier Wells score and an age-adjusted D-dimer, and get the guideline next step. Instant, browser-side.
Pulmonary Embolism Pathway (Wells-PE + D-dimer)
Clinical signs of DVT (leg swelling + tenderness)
PE is the most likely diagnosis (or as likely as alternatives)
Heart rate > 100 bpm
Immobilisation ≥ 3 days or surgery in the past 4 weeks
Previous DVT / PE
Haemoptysis
Active malignancy (on treatment / palliative / within 6 months)
Age (for age-adjusted D-dimer) (yr)
D-dimer (µg/L FEU, leave blank if not measured) (µg/L)
When to use
Decide whether to exclude PE, order a D-dimer, or proceed to CTPA in a haemodynamically stable patient.
How it works
Wells-PE (DVT signs 3, PE most likely 3, HR > 100 1.5, immobilisation/surgery 1.5, prior VTE 1.5, haemoptysis 1, malignancy 1); > 4 = PE likely. Age-adjusted D-dimer cut-off = age × 10 µg/L FEU for age > 50.
Key points
- PE likely (> 4) → CTPA directly; a negative D-dimer does not exclude PE here.
- PE unlikely (≤ 4) → D-dimer below the (age-adjusted) cut-off excludes PE without imaging.
- The age-adjusted cut-off applies only to patients > 50 with low clinical probability.
- Haemodynamically unstable patients are treated as high-risk PE and do not follow this pathway.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.