Simplified PESI (PE Severity)
Calculates the simplified PESI in acute PE and separates low risk (0 points) from high risk (1 or more).
When to use
Prognostic stratification of adults with confirmed acute symptomatic pulmonary embolism, to identify the group at low risk of death within 30 days. It does not decide admission on its own and does not confirm the diagnosis.
Pearls and pitfalls
- Age is dichotomized: only above 80 years adds 1 point, so a patient aged exactly 80 years scores nothing for age.
- Heart failure and chronic lung disease were merged into a single item, so both together still add only 1 point.
- Sex, respiratory rate, temperature and altered mental status were dropped from the original PESI because they did not reach statistical significance in derivation.
- The score was built to find the low-risk group, not to grade increasing risk: there are only two categories, 0 and 1 or more.
- In derivation, 305 of 995 patients (30.7%) scored 0 and had 1.0% 30-day mortality, against 10.9% in the 1 point or more group.
- Missing prognostic variables were assumed to be normal in derivation, the same strategy used for the original PESI.
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Formula
1 point for each item present among age older than 80 years, cancer, chronic cardiopulmonary disease, heart rate ≥ 110 bpm, systolic pressure < 100 mmHg and arterial saturation < 90%. Total from 0 to 6 points.
Evidence
Derived in 995 patients from a Spanish registry and validated in 7,106 patients from the international RIETE cohort. The C statistic was 0.75 (95% CI, 0.69 to 0.80), the same as the original PESI, and the Hosmer-Lemeshow statistic was 5.13 (P = 0.74). In the low-risk group, 30-day mortality was 1.1% in validation.
References
- Jiménez D, Aujesky D, Moores L, et al. Simplification of the Pulmonary Embolism Severity Index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010;170(15):1383-1389. doi:10.1001/archinternmed.2010.199
- Aujesky D, Obrosky DS, Stone RA, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005;172(8):1041-1046. doi:10.1164/rccm.200506-862OC
Frequently asked questions
What is Simplified PESI (PE Severity)?
Calculates the simplified PESI in acute PE and separates low risk (0 points) from high risk (1 or more). Prognostic stratification of adults with confirmed acute symptomatic pulmonary embolism, to identify the group at low risk of death within 30 days. It does not decide admission on its own and does not confirm the diagnosis.
How is the result calculated?
1 point for each item present among age older than 80 years, cancer, chronic cardiopulmonary disease, heart rate ≥ 110 bpm, systolic pressure < 100 mmHg and arterial saturation < 90%. Total from 0 to 6 points.
How should the result be interpreted?
Derived in 995 patients from a Spanish registry and validated in 7,106 patients from the international RIETE cohort. The C statistic was 0.75 (95% CI, 0.69 to 0.80), the same as the original PESI, and the Hosmer-Lemeshow statistic was 5.13 (P = 0.74). In the low-risk group, 30-day mortality was 1.1% in validation.
What are the sources?
Jiménez D, Aujesky D, Moores L, et al. Simplification of the Pulmonary Embolism Severity Index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010;170(15):1383-1389. Aujesky D, Obrosky DS, Stone RA, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005;172(8):1041-1046.