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Pulmonary Embolism
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Simplified PESI (Pulmonary Embolism Severity Index)

Predicts 30-day outcome of patients with PE, with fewer criteria than the original PESI.

About the Creator
Dr. David Jiménez
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Advice

  • 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).

Management

  • 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.

Critical Actions

  • 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.
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