Pulmonary Embolism Severity Index (PESI) Calculator

Calculate Pulmonary Embolism Severity Index (PESI) score for 30-day mortality risk assessment in patients with acute pulmonary embolism. Free online calculator for clinical decision support.

Pulmonary Embolism Severity Index (PESI) Calculator

Age (years) *

1 point per year

Gender

Male (+10 points)Female

Medical History

History of Cancer (+30 points)History of Heart Failure (+10 points)History of Chronic Lung Disease (+10 points)

Vital Signs

Pulse Rate (bpm)

≥110 bpm: +20 points

Systolic Blood Pressure (mmHg)

<100 mmHg: +30 points

Respiratory Rate (breaths/min)

≥30 breaths/min: +20 points

Temperature (°C)

<36°C: +20 points

Arterial Oxygen Saturation (%)

<90%: +20 points

Neurological Status

Altered Mental Status (+60 points)

Disclaimer: This calculator is for educational purposes only and should not replace clinical judgment. The PESI score helps estimate 30-day mortality risk but should be used in conjunction with clinical assessment and individual patient factors.

PESI Formula Explained

Risk Factor Scoring

Risk Factor	Points	Definition
Age	1 per year	Patient age in years
Male Sex	+10	Male gender
History of Cancer	+30	Active or metastatic cancer
History of Heart Failure	+10	History of congestive heart failure
History of Chronic Lung Disease	+10	COPD, asthma, or other chronic lung disease
Pulse Rate ≥110 bpm	+20	Heart rate ≥110 beats per minute
Systolic BP <100 mmHg	+30	Systolic blood pressure <100 mmHg
Respiratory Rate ≥30 breaths/min	+20	Respiratory rate ≥30 breaths per minute
Temperature <36°C	+20	Body temperature <36°C (96.8°F)
Altered Mental Status	+60	Disorientation, lethargy, stupor, or coma
Arterial O₂ Saturation <90%	+20	Oxygen saturation <90% (on room air or with supplemental O₂)

Risk Class Interpretation

Class I

Very Low Risk

≤65 points

0-1.6% mortality

Class II

Low Risk

66-85 points

1.7-3.5% mortality

Class III

Intermediate Risk

86-105 points

3.2-7.1% mortality

Class IV

High Risk

106-125 points

4.0-11.4% mortality

Class V

Very High Risk

>125 points

10.0-24.5% mortality

Clinical Guidelines

Management Recommendations

• Class I-II (Low Risk): Consider outpatient management or early discharge
• Class III (Intermediate Risk): Standard inpatient management
• Class IV-V (High Risk): Consider intensive care monitoring and aggressive treatment
• PESI score should be used in conjunction with clinical judgment and patient-specific factors
• Consider hemodynamic stability, right ventricular dysfunction, and bleeding risk

Key Considerations

• PESI predicts 30-day all-cause mortality
• Validated in multiple studies and clinical settings
• Can help identify low-risk patients suitable for outpatient treatment
• Should not be used alone for treatment decisions
• Consider patient preferences and social factors

Important Limitations

• PESI score estimates 30-day all-cause mortality, not PE-specific mortality
• Does not account for bleeding risk or contraindications to anticoagulation
• Should be used in conjunction with clinical judgment and patient assessment
• Consider hemodynamic status, right ventricular function, and biomarkers
• Patient comorbidities and social factors may influence management decisions
• Regular reassessment may be needed as patient condition changes

Pulmonary Embolism Severity Index (PESI)

The Pulmonary Embolism Severity Index (PESI) is a validated clinical prediction rule used to assess the 30-day mortality risk in patients with acute pulmonary embolism (PE). Developed to help clinicians stratify patients and guide treatment decisions, the PESI score evaluates 11 clinical variables including age, sex, vital signs, and comorbidities. The score ranges from 0 to over 400, with higher scores indicating increased mortality risk.

Patients are classified into five risk classes (I-V), with class I representing the lowest risk and class V representing the highest risk. The PESI score helps identify low-risk patients who may be candidates for outpatient treatment or early discharge, as well as high-risk patients who require intensive monitoring and aggressive management.

Clinical Application

The PESI score is widely used in emergency departments and inpatient settings to guide treatment decisions for patients with acute pulmonary embolism. Low-risk patients (PESI classes I and II) may be candidates for outpatient treatment or early discharge with close follow-up, while high-risk patients (PESI classes IV and V) typically require hospitalization and intensive monitoring.

Risk Stratification

The PESI score evaluates the following clinical variables:

Age
Sex
History of cancer
History of heart failure
History of chronic lung disease
Heart rate
Systolic blood pressure
Respiratory rate
Temperature
Altered mental status
Oxygen saturation

Each variable is assigned a point value, and the total score determines the risk class and associated 30-day mortality risk.