MDCalc

4-Level Pulmonary Embolism Clinical Probability Score (4PEPS)

Rules out PE based on clinical criteria.

The timing of vital sign values were not formally assessed by this study; we recommend using clinician judgment to assess which vital sign should be used for the 4PEPS score.

years
Sex
Chronic respiratory disease
Heart rate <80
Chest pain AND acute dyspnea
Current estrogen use
Prior history of VTE
Syncope
Immobility within the last four weeks
Surgery, lower limb plaster cast, or bedridden >3 days for acute medical condition within the last four weeks
O2 saturation <95%
Calf pain and/or unilateral lower limb edema
PE is the most likely diagnosis

Result:

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Advice

The results of this tool should not replace clinical judgment; always consider individual patient context and atypical presentations.

Management

Suggested management based on clinical probability results:

  • Very low (<0): PE can be ruled out based on clinical criteria without further testing.
  • Low (0-5): Check a d-dimer level. If <1.0 μg/mL, PE can be ruled out. Otherwise, proceed to imaging.
  • Moderate (6-12): Check a d-dimer level. If <0.5 μg/mL OR <(age x 0.01) μg/mL, PE can be ruled out. Otherwise, proceed to imaging.
  • High (≥13): Proceed to imaging.
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