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    Patent Pending

    Pulmonary Embolism Severity Index (PESI)

    Predicts 30-day outcome of patients with pulmonary embolism using 11 clinical criteria.
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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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