- Social situation should be taken into account before considering outpatient management (including the appropriate administration of anticoagulants).
- Fewer patients were classified as low risk by sPESI than PESI, and the sPESI derivation cohort had patients with more comorbidities than the original.
- Given low mortality of low risk PE, outpatient management would save significant funds over hospitalization (cited as $4,500 per avoided admission).
- If the patient is considered low risk (score of 0) by the sPESI:
- Patient has an overall low risk of mortality (1.1%) or severe morbidity (1.5%).
- Consider outpatient management of PE if clinically appropriate and social factors allow for it.
- If the patient is considered high risk (score of ≥ 1) by the sPESI:
- Patient has an overall high risk of mortality (8.9%) or severe morbidity (2.7%).
- Consider inpatient management and higher levels of care if clinically appropriate.
- The sPESI is only meant for risk stratification of pulmonary embolism after the diagnosis has been made.
- The sPESI can not be used to risk stratify patients who are not being treated for PE.
- Additional pathology which could lead to morbidity or mortality should not be overlooked in the setting of low risk sPESI scores.