Pulmonary Embolism Severity Index (PESI) Score Calculator

Age (years)

Patient's age in years (1 point per year)

Gender

Male gender (+10 points)

MaleFemale

Cancer

+30

Active cancer (treatment within 6 months, palliative, or metastatic)

Heart failure

+10

Chronic heart failure

Chronic lung disease

+10

Chronic obstructive pulmonary disease

Pulse ≥ 110/min

+20

Heart rate ≥ 110 beats per minute

Systolic BP < 100 mmHg

+30

Systolic blood pressure < 100 mmHg

Respiratory rate > 30/min

+20

Respiratory rate > 30 breaths per minute

Temperature < 36°C

+20

Body temperature < 36°C (96.8°F)

Altered mental status

+60

Confusion, disorientation, or lethargy

Oxygen saturation < 90%

+20

Arterial oxygen saturation < 90%

Risk Stratification

Class I (≤65 points): Very low risk (0-1.6% mortality) - Consider outpatient treatment
Class II (66-85 points): Low risk (1.7-3.5% mortality) - Consider outpatient treatment
Class III (86-105 points): Intermediate risk (3.2-7.1% mortality) - Consider hospital admission
Class IV (106-125 points): High risk (4.0-11.4% mortality) - Hospital admission recommended
Class V (>125 points): Very high risk (10.0-24.5% mortality) - Hospital admission required

Pulmonary Embolism Severity Index (PESI) Score Calculator

The Pulmonary Embolism Severity Index (PESI) is a validated clinical prediction rule for assessing the severity of acute pulmonary embolism (PE) and predicting 30-day mortality risk. It helps guide decisions regarding hospital admission, outpatient treatment, and level of care.

Components of PESI

The PESI score is calculated by assigning points for each of the following 11 variables:

Age: 1 point per year of age
Male sex: +10 points
Cancer: +30 points (active cancer within 6 months, palliative, or metastatic)
Heart failure: +10 points (chronic heart failure)
Chronic lung disease: +10 points (chronic obstructive pulmonary disease)
Pulse ≥ 110/min: +20 points
Systolic BP < 100 mmHg: +30 points
Respiratory rate > 30/min: +20 points
Temperature < 36°C: +20 points
Altered mental status: +60 points (confusion, disorientation, lethargy)
Oxygen saturation < 90%: +20 points

Risk Stratification

Class I (≤65 points) - Very Low Risk

30-day mortality: 0-1.6%
Recommendation: Consider outpatient treatment
Clinical features: Hemodynamically stable, no right ventricular dysfunction

Class II (66-85 points) - Low Risk

30-day mortality: 1.7-3.5%
Recommendation: Consider outpatient treatment
Clinical features: Generally stable, may have minor comorbidities

Class III (86-105 points) - Intermediate Risk

30-day mortality: 3.2-7.1%
Recommendation: Consider hospital admission
Clinical features: May have signs of right ventricular dysfunction

Class IV (106-125 points) - High Risk

30-day mortality: 4.0-11.4%
Recommendation: Hospital admission recommended
Clinical features: Significant comorbidities, hemodynamic compromise

Class V (>125 points) - Very High Risk

30-day mortality: 10.0-24.5%
Recommendation: Hospital admission required, consider ICU
Clinical features: Hemodynamic instability, severe comorbidities

Clinical Applications

Outpatient vs. Inpatient Decision

Low risk (Class I-II): Generally safe for outpatient treatment with appropriate follow-up
Intermediate risk (Class III): Consider hospital admission, especially if comorbidities present
High risk (Class IV-V): Hospital admission recommended, consider ICU for Class V

Treatment Considerations

Anticoagulation: All patients require anticoagulation regardless of risk class
Thrombolysis: Consider for hemodynamically unstable patients (Class V)
Monitoring: Higher classes require closer monitoring
Follow-up: More frequent follow-up for higher risk classes

Important Considerations

Limitations

Not validated for subsegmental PE
May underestimate risk in patients with massive PE
Does not account for social factors or access to care
Should be used in conjunction with clinical judgment
Not a substitute for hemodynamic assessment

Additional Factors to Consider

Right ventricular function: Assess with echocardiography or CT
Troponin levels: Elevated troponin indicates myocardial injury
BNP/NT-proBNP: Elevated levels suggest right ventricular strain
Social factors: Access to care, compliance, support systems
Comorbidities: Renal failure, liver disease, bleeding risk

Comparison with Other Scores

PESI vs. sPESI (Simplified PESI)

PESI: More complex but more accurate
sPESI: Simpler, easier to calculate at bedside
Clinical use: sPESI preferred for rapid assessment

PESI vs. HESTIA Criteria

PESI: Prognostic tool for mortality prediction
HESTIA: Decision tool for outpatient treatment
Clinical use: Can be used together for comprehensive assessment

Clinical Pearls

Always use clinical judgment in addition to the score
Consider patient preferences and social circumstances
Monitor for clinical deterioration regardless of initial score
Reassess severity if patient condition changes
Use in conjunction with imaging findings and laboratory results
Consider right ventricular assessment in intermediate-high risk patients

This calculator provides a validated method for assessing PE severity and guiding treatment decisions. The PESI score is widely used in clinical practice and has been validated in multiple populations and settings.

References

Aujesky, D., Obrosky, D. S., Stone, R. A., Auble, T. E., Perrier, A., Cornuz, J., ... & Fine, M. J. (2005). Derivation and validation of a prognostic model for pulmonary embolism. American Journal of Respiratory and Critical Care Medicine, 172(8), 1041-1046.
Jiménez, D., Aujesky, D., Moores, L., Gómez, V., Lobo, J. L., Uresandi, F., ... & Yusen, R. D. (2010). Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Archives of Internal Medicine, 170(15), 1383-1389.
Kearon, C., Akl, E. A., Ornelas, J., Blaivas, A., Jimenez, D., Bounameaux, H., ... & Moores, L. (2016). Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest, 149(2), 315-352.
Konstantinides, S. V., Meyer, G., Becattini, C., Bueno, H., Geersing, G. J., Harjola, V. P., ... & Zamorano, J. L. (2020). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). European Heart Journal, 41(4), 543-603.
Righini, M., Roy, P. M., Meyer, G., Verschuren, F., Aujesky, D., & Le Gal, G. (2006). The Simplified Pulmonary Embolism Severity Index (PESI): validation of a clinical prognostic model for pulmonary embolism. Journal of Thrombosis and Haemostasis, 4(4), 744-749.

Loading PDF...