🫁 Pulmonary Embolism Pathway (Wells-PE + D-dimer)
UseDecide whether to exclude PE, order a D-dimer, or proceed to CTPA in a haemodynamically stable patient.
SourceKonstantinides SV, et al. 2019 ESC Guidelines for acute pulmonary embolism. Eur Heart J 2020
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
- Who it is for
- Adults with suspected acute PE when deciding whether to test further, and risk stratification after confirmation.
- Who it is not for
- PERC must not rule out PE when clinical probability is not already low. Confirmed PE does not return to PERC. PERC is not an atrial-fibrillation tool and not a treatment page.
- Formula and variables
- Wells PE and revised Geneva estimate clinical probability; the version stays as on this page. PERC is used only when probability is already low, to see whether testing can stop. BOVA is only for normal blood pressure. Hestia only answers outpatient eligibility. No new score.
- Result → next step
- If probability is low and every PERC item is negative, stop further PE testing; otherwise test. The treatment column stays empty before confirmation. After confirmation, duration opens the anticoagulation-duration page. That link is not hung on PERC. Numeric dose waits for age, weight, renal function, and pregnancy.No numeric dose until age, weight, renal function, and pregnancy are all known. Pregnancy is contraindication or caution only.Duration after confirmation →
- Guideline
- 2019 ESC PE
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Methodology · worked example, guidelines & full notes
PE likely (> 4) → CTPA directly; a negative D-dimer does not exclude PE here.
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
- [Guideline / primary source]Konstantinides SV, et al. 2019 ESC Guidelines for acute pulmonary embolism. Eur Heart J 2020
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Pulmonary Embolism Pathway (Wells-PE + D-dimer)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Pulmonary Embolism Pathway (Wells-PE + D-dimer) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.