🫁 PESI (Pulmonary Embolism Severity Index)
UseRisk-stratify PE and support outpatient vs inpatient decisions.
StrataClasses I–II are lower 30-day mortality (often outpatient candidates if no RV dysfunction or raised biomarker…
LimitsPESI does not replace RV strain imaging or biomarker risk staging in … · Cancer and age dominate points — clinical gestalt still matters for d… · sPESI is simpler when a binary low vs high split is enough.
SourceAujesky D, et al. Am J Respir Crit Care Med 2005; 2019 ESC/ERS acute PE guideline; China PTE guidel…
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
- Who it is for
- Adults with suspected acute PE when deciding whether to test further, and risk stratification after confirmation.
- Who it is not for
- PERC must not rule out PE when clinical probability is not already low. Confirmed PE does not return to PERC. PERC is not an atrial-fibrillation tool and not a treatment page.
- Formula and variables
- Wells PE and revised Geneva estimate clinical probability; the version stays as on this page. PERC is used only when probability is already low, to see whether testing can stop. BOVA is only for normal blood pressure. Hestia only answers outpatient eligibility. No new score.
- Result → next step
- If probability is low and every PERC item is negative, stop further PE testing; otherwise test. The treatment column stays empty before confirmation. After confirmation, duration opens the anticoagulation-duration page. That link is not hung on PERC. Numeric dose waits for age, weight, renal function, and pregnancy.No numeric dose until age, weight, renal function, and pregnancy are all known. Pregnancy is contraindication or caution only.Next step: for most patients without high-risk PE, initial anticoagulation is LMWH, fondaparinux, or a DOAC that can be started directly. If IV unfractionated heparin is needed (high-risk PE, possible reperfusion, severe renal impairment, or severe obesity), work out the starting regimen with weight-based UFH →Duration after confirmation →
- Guideline and review date
- 2019 ESC/ERS PE; China PTE guideline 2025 · reviewed 2026-10-06
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Methodology · worked example, guidelines & full notes
Classes I–II are low risk; may allow outpatient care if no RV dysfunction and cardiac biomarkers are not elevated (ESC 2019).
When to use
Risk-stratify PE and support outpatient vs inpatient decisions.
How it works
Age in years plus points (male 10, cancer 30, HF 10, lung 10, HR ≥110 20, SBP <100 30, RR ≥30 20, temp <36 20, altered mentation 60, SaO₂ <90% 20). Classes I (≤65) to V (>125).
Key points
- Classes I–II are low risk; may allow outpatient care if no RV dysfunction and cardiac biomarkers are not elevated (ESC 2019).
- Classes III–V: not low risk by PESI; complete risk stratification with haemodynamics, RV function and cardiac troponin (ESC 2019).
- sPESI is a simpler binary alternative.
References
- [Original paper / primary source]Aujesky D, et al. Am J Respir Crit Care Med 2005; 2019 ESC/ERS acute PE guideline; China PTE guideline 2025
- [Guideline basis]Guideline source: 2019 ESC/ERS Guidelines for the diagnosis and management of acute pulmonary embolism (Konstantinides SV, et al. Eur Heart J 2020;41(4):543–603. doi:10.1093/eurheartj/ehz405); Chinese guidelines for the diagnosis, treatment, prophylaxis and management of pulmonary thromboembolism, 2025 edition (Natl Med J China 2025;105(26):2162–2194. doi:10.3760/cma.j.cn112137-20250509-01141). Original derivation: Aujesky D, et al. Am J Respir Crit Care Med 2005;172(8):1041–1046. doi:10.1164/rccm.200506-862OC.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Age | 70 years |
|---|---|
| Male sex | No |
| Cancer | No |
| Heart failure | No |
| Chronic lung disease | No |
| Heart rate ≥ 110 | No |
| Systolic BP < 100 | No |
| Respiratory rate ≥ 30 | No |
| Temperature < 36°C | No |
| Altered mental status | No |
| SaO₂ < 90% | No |
→PESI70pts
- Class：II — low (1.7–3.5%) 30-day mortality
- Disposition：Classes I–II: low risk; may be candidates for outpatient treatment. If echocardiography/CTPA shows RV dysfunction or cardiac biomarkers are elevated, classify as intermediate risk (ESC 2019).
| Age | 70 years |
|---|---|
| Male sex | Yes (+10) |
| Cancer | Yes (+30) |
| Heart failure | Yes (+10) |
| Chronic lung disease | Yes (+10) |
| Heart rate ≥ 110 | Yes (+20) |
| Systolic BP < 100 | Yes (+30) |
| Respiratory rate ≥ 30 | Yes (+20) |
| Temperature < 36°C | Yes (+20) |
| Altered mental status | Yes (+60) |
| SaO₂ < 90% | Yes (+20) |
→PESI300pts
- Class：V — very high (10.0–24.5%) 30-day mortality
- Disposition：Classes III–V: not low risk by PESI; complete risk stratification with haemodynamics, RV function and cardiac troponin (ESC 2019).
Verification & sources · governance
FAQ
Frequently asked questions
- Does PESI (Pulmonary Embolism Severity Index) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.