MDCalc

Pulmonary Embolism Severity Index (PESI)

Predicts 30-day outcome of patients with pulmonary embolism.

years
Sex
History of cancer
History of heart failure
History of chronic lung disease
Heart rate ≥110
Systolic BP <100 mmHg
Respiratory rate ≥30
Temperature <36°C/96.8°F
Altered mental status (disorientation, lethargy, stupor, or coma)
O2 saturation <90%

Result:

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Advice
  • Social situation should also be taken into account before considering outpatient management (including the appropriate administration of anticoagulants).
  • Given low mortality of low risk PE, outpatient management would save significant funds over hospitalization (cited as $4,500 per avoided admission).
  • The non-inferiority trial showed successful and safe outpatient management of Class I and II patients.
Management
  • If the patient is considered very low (≤ 65) or low risk (66-85) by the PESI score.
    • Patient has an overall low risk of mortality or severe morbidity.
    • Consider outpatient management of PE if clinically appropriate and social factors allow for it.
  • If the patient is considered intermediate (86-105), high risk (106-125) or very high risk (>125) by the PESI.
    • Patient has an overall high risk of mortality and severe morbidity.
    • Consider higher levels of care (e.g., ICU) for those with higher scores.
Critical Actions
  • The PESI is only meant for risk stratification of pulmonary embolism after the diagnosis has been made.
  • Findings which could point toward clinically significant PE should not be overlooked in the setting of a low PESI score.
  • Additional pathology which could lead to morbidity or mortality should not be overlooked in the setting of a low PESI score.
  • All results for the validation of the PESI were made with patients who were treated for PE initially with enoxaparin, and then encouraged to transition to vitamin K antagonists.
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