Discrepancy Between Clinician Gestalt and Subjective Component of the Wells Score in the Evaluation of Pulmonary Embolism

Schriger et al1 recently showed that studies rarely compare decision aids with physician judgment. In the evaluation of pulmonary embolism, clinicians may use either their subjective clinical judgment (ie, gestalt) or a decision aid (eg, Wells score) to determine the pretest probability of pulmonary embolism. Research shows that the Wells score and clinical gestalt are similarly accurate.2,3 Research also suggests that most of the predictive power of the Wells score lies in its subjective question, "Are alternative diagnoses less likely than pulmonary embolism?"4 However, the degree to which the subjective component of the Wells score and clinician gestalt are correlated is not known.

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