Pulmonary Embolism Severity Index (PESI)

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Use this calculator to estimate prognosis (30-day mortality) using the Pulmonary Embolism Severity Index.

Age (yrs)
Male?
History of Cancer?
History of Heart Failure?
History of Chronic Lung Disease?
Pulse ≥ 110/min
Systolic BP <100 mmHg
Respiratory Rate ≥ 30/min
Temperature < 36° C / 96.8° F
Altered Mental Status
Defined as disorientation, lethargy, stupor or coma
Arterial oxygen saturation < 90%

About this calculator

This risk calculator was derived from more than 15000 patients with pulmonary embolism and then externally validated.  While somewhat cumbersome due to the need to input 11 patient characteristics, it has been independently validated (unlike the simplified Pulmonary Embolism Severity Index) and able to stratify patients into 5 risk classes.

The patient factors independently associated with 30-day mortality included age, sex, three comorbid illnesses (cancer, heart failure, chronic lung disease), and six clinical findings (pulse ⩾ 110/minute, systolic blood pressure < 100 mm Hg, respiratory rate ⩾ 30/minute, temperature < 36°C, altered mental status, and oxygen saturation < 90%.

A score is assigned by summing the patient’s age in years and the points for each characteristic present.

Variable & Associated Points

Age | Age in years
Male sex | +10
Cancer | +30
Heart Failure | +10
Chronic lung disease | +10
Pulse ⩾ 110/min | +20
Systolic BP < 100 mm Hg | +30
Respiratory rate ⩾ 30/min | + 20
Temperature < 36°C |+ 20
Altered mental status | + 60
Arterial oxygen saturation < 90% | +20

Points assignments correspond with the following risk classes:

⩽ 65: class I, very low risk
66–85: class II, low risk
86–105: class III, intermediate risk
106–125: class IV, high risk
> 125: class V, very high risk

Citation

Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, Roy PM, Fine MJ. Derivation and validation of a prognostic model for pulmonary embolism.  Am J Respir Crit Care Med. 2005;172(8):1041.