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About

The Pulmonary Embolism Severity Index (PESI) is a validated clinical prognostic rule used to estimate the 30-day mortality risk for patients diagnosed with acute pulmonary embolism (PE). Its primary clinical utility lies in identifying low-risk patients (Class I or II) who may be eligible for outpatient management or early discharge, thereby reducing hospital admissions and healthcare costs.

This tool offers both the original PESI score (which uses granular scoring) and the Simplified PESI (sPESI) (which uses a binary approach). Accurate risk stratification prevents both the overtreatment of stable patients and the undertreatment of those at high risk for rapid decompensation.

PESI score pulmonary embolism medical calculator risk stratification sPESI

Formulas

The PESI score is an additive model summing demographic and clinical variables:

Score = Age + MalePoints + Cancer + HF + LungDis + Vitals

Specific point allocations are:

{
Age: + 1 per yearMale: + 10Cancer: + 30Heart Failure: + 10Lung Disease: + 10Pulse110: + 20SBP < 100: + 30RR30: + 20Temp < 36°C: + 20Altered Mental Status: + 60

Reference Data

Risk ClassTotal Points (PESI)30-Day Mortality RiskRecommendation
Class I65Very Low (0-1.6%)Outpatient eligible
Class II66 - 85Low (1.7-3.5%)Consider early discharge
Class III86 - 105Moderate (3.2-7.1%)Inpatient admission
Class IV106 - 125High (4.0-11.4%)Inpatient / Monitoring
Class V> 125Very High (10.0-24.5%)ICU / Hemodynamic support

Frequently Asked Questions

PESI provides a detailed score (0-200+) stratified into 5 classes. sPESI (Simplified PESI) uses fewer variables and a simple 1-point system. If a patient has 0 points in sPESI, they are Low Risk; 1 or more points indicates High Risk.
No. The PESI score is a support tool. It does not account for social factors (e.g., patient lives alone), bleeding risks, or renal function, which are crucial for determining outpatient safety.
In the original validation, this refers to disorientation, lethargy, stupor, or coma. It is the most heavily weighted factor (+60 points) because it often indicates hemodynamic shock or severe hypoxia.
No. This score is only validated for patients with a *confirmed* diagnosis of Pulmonary Embolism.