Simplified PESI (Pulmonary Embolism Severity Index: sPESI)
Estimates the 30-day mortality risk following acute pulmonary embolism.
Reference
Summary
The sPESI was designed to remove the complexity associated with the elements of the Pulmonary Embolism Severity Index (PESI) Risk Calculator in risk stratifying patients with Pulmonary Embolism (PE).
The sPESI has been:
- Shown to be equally accurate as the PESI in predicting the 30-day mortality after acute PE.
- Externally validated, demonstrating good discrimination, calibration, and generalizability of its predictive accuracy.
- Found to be predictive of high-risk adverse outcomes with a sensitivity of 94% and specificity of 40%.
Validation Studies: Jimenez 2010, Zhou 2012, Lankeit 2011.
It is important to note that:
- The sPESI is only meant for risk stratification of PE following diagnosis, and can not be used to risk stratify patients without PE.
- Additional pathology which could lead to morbidity or mortality should not be overlooked in the setting of low risk sPESI scores.
- The patient's social situation should be taken into account alongside the sPESI score, when determining the appropriateness of outpatient PE management.
The sPESI is meant to aid in clinical decision making, not as a replacement. Clinical judgement should always take precedence.
In the setting of renal failure or severe complicating comorbidities, clinical judgement should be used over the ePESI, as these patients were excluded in the validation studies.
Criteria
If any of the following criteria is/are present, the patient is considered to have a HIGH 30-day mortality risk (8.9% or greater).
| Age (years) | ≤ 80 (0 points) | > 80 (1 point) |
| Heart Rate (bpm) | < 110 (0 points) | ≥ 110 (1 point) |
| Oxygen Saturation | ≥ 90% (0 points) | < 90% (1 point) |
| Systolic Blood Pressure | ≥ 100(0 points) | < 100 (1 point) |
| History of Cancer | No (0 points) | Yes (1 point) |
| History of Chronic Cardiopulmonary Disease | No (0 points) | Yes (1 point) |
Results
Low-Mortality Risk: sPESI = 0
If no criteria are positive, the 30-day risk of mortality is 1.1%.
Patient may be a candidate for Outpatient PE management.
High Mortality Risk: sPESI ≥ 1
If any criteria are positive, the 30-day risk of mortality is 8.9% or higher.
Patient is a candidate for Inpatient PE management.
Instructions
The Simplified PESI (sPESI) is used in the setting of acute pulmonary embolism (PE) to estimate a patient's 30-day mortality risk. This value helps determine if the patient is a candidate for outpatient PE management.
Patients with a LOW mortality risk (ePESI of 0) may be candidate for OUTPATIENT PE management (30-day mortality risk of 1.1%).
Patients with HIGH mortality risk (ePESI of 1 or greater) are recommended for INPATIENT PE management (30-day mortality risk of 8.9% or greater).
Literature
- Derivation and validation of a prognostic model for pulmonary embolism — Aujesky D, Obrosky D, Stone R, et al.
- Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism — Jimenez D, Aujesky D, Moores L, et al.
- The prognostic value of pulmonary embolism severity index in acute pulmonary embolism: a meta-analysis — Zhou X, Ben S, Chen H, and Ni S
- Predictive value of the high-sensitivity troponin T assay and the simplified Pulmonary Embolism Severity Index in hemodynamically stable patients with acute pulmonary embolism: a prospective validation study — Lankeit M, Jimenez D, Kostrubiec M, et al.
- Kelly Rudd , PharmD, BCPS, CACP, FCCP — Clinical Associate Professor of Medicine, Oklahoma State University Center for Health Sciences