Pulmonary Embolism Severity Index (PESI)
Predicts 30-day outcome of patients with pulmonary embolism.
Advice
- Social determinants of health should be taken into account before considering outpatient management (including access to anticoagulants and prompt follow-up care for further workup and management, typically within 7 days).
- Given low mortality of low risk PE, outpatient management would save significant healthcare costs over hospitalization (~5000 EUR per avoided admission per Ghazvinian et al, 2020).
- For those determined to be very low risk (score ≤ 65), all studies showed a 30-day mortality of <2%; in the first validation, low risk (Class I and II) had a 90-day mortality of 1.1%.
- A non-inferiority trial demonstrated Class I and II could have been treated as outpatients assuming no other medical or social issues.
Management
- If the patient is considered very low (≤ 65) or low risk (66-85) by the PESI score:
- They have 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 (106-125), or very high risk (>125):
- They have an overall high risk of mortality and severe morbidity.
- Consider higher levels of care (e.g., ICU) for those with higher scores.
Critical Actions
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Renal failure or patients with other significant comorbidities should be considered separately as these patients were not included in the validation study.
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PESI poorly predicts morbidity/mortality in intermediate risk groups.
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CT angiography-measured parameters can be superior to PESI in predicting 30-day mortality.
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Pro-BNP levels, RV function, and the presence of right-heart thrombus may also affect a patient's risk assessment.