Confirmed PE — Why Score It At All
Scoring starts the moment imaging confirms clot.
- ~900K: PE incidence (US/yr) (estimated annual cases)
- 11: PESI variables (age + 10 clinical factors)
- Multiple: Validation cohorts (derivation + external)
- Triage: Purpose (home vs hospital decision)
Why risk-stratify PE
Not every PE needs a hospital bed. Scoring finds the safe-to-discharge group.
Placeholder: low-risk patients can often go home safely.
What PESI measures
Age plus nine clinical and vital-sign variables, summed into one score.
Original vs simplified
A simplified PESI (sPESI) also exists as a binary yes/no version.
Age Points — One Point Per Year
Age enters the score directly, unlike other variables.
- 18–95: Age range modeled (slider bounds)
- 1: Points per year (direct contribution)
- ~95 pts: Max age contribution (at oldest end)
- Fixed pts: Other variables (not scaled by severity)
Why age is linear
Age tracks mortality risk closely, so it is added as raw years.
Placeholder: older patients start with a higher baseline score.
Baseline before comorbidity
Age alone can already push a patient toward a higher class.
Interpreting the bar
The blue segment in the chart always equals patient age.
Cancer, Heart Failure, Lung Disease
Three chronic conditions each add fixed point values.
- +30: Cancer history (points if present)
- +10: Heart failure (points if present)
- +10: Chronic lung disease (points if present)
- 50: Max comorbidity total (all three present)
Cancer weighting
Active cancer carries the largest comorbidity weight, 30 points.
Placeholder: cancer history alone can shift risk class meaningfully.
Cardiopulmonary disease
Heart failure and chronic lung disease each add 10 points.
Stacking on the chart
Orange blocks stack above the age bar in the tally.
Tachycardia, Hypotension, Hypoxemia & More
Abnormal exam findings add the largest point values.
- +60: Altered mental status (highest single weight)
- +30: Systolic BP <100 (hypotension)
- +20 ea: Resp rate / O2 / HR / temp (four separate factors)
- 170: Max vital-sign total (all six present)
Mental status dominates
Altered mental status alone adds 60 points, the biggest weight.
Placeholder: vital-sign abnormalities often decide the risk class.
Hemodynamic instability
Low systolic blood pressure signals possible right heart strain.
Respiratory and thermal signs
Tachypnea, hypoxemia, tachycardia, and hypothermia each add points.
Risk Class I–V & Disposition
Total score sorts patients into five mortality classes.
- Outpatient: Class I–II (score ≤85, low mortality)
- Inpatient: Class III–V (score >85, hospitalize)
- 0–1.6%: Class I mortality (very low risk)
- 10–24.5%: Class V mortality (very high risk)
Five risk classes
Score thresholds at 65, 85, 105, 125 define classes I through V.
Placeholder: class III is the tipping point toward hospitalization.
Outpatient eligibility
Class I–II patients are candidates for safe home treatment.
Using the score responsibly
PESI supports, but does not replace, overall clinical judgment.
Risk class reference