One discussion this week included the application of the Pulmonary Embolism Severity Index (PESI) score.

Reference: Aujesky D. Pulmonary Embolism Severity Index (PESI) [online calculator]. Retrieved from https://www.mdcalc.com/pulmonary-embolism-severity-index-pesi

Summary: WHEN TO USE: In the setting of a patient diagnosed with PE, the PESI can be utilized to determine mortality and long term morbidity.

PEARLS/PITFALLS: PESI is a risk stratification tool that has been externally validated to determine the mortality and outcome of patients with newly diagnosed pulmonary embolism (PE).

In the setting of a patient with renal failure or severe comorbidities, clinical judgement should be used over the PESI, as these patients were excluded in the validation study.

• The PESI score determines risk of mortality and severity of complications.
• The score does not require laboratory variables.
• It is meant to aid in decision making, not replace it. Clinical judgement should always take precedence.
• The PESI score determines clinical severity and can influence treatment setting for management of PE.
  • Class I and II patients may possibly be safely treated as outpatients in the right clinical setting.

Go to MD Calc for the calculator below:

Additional Reading: Aujesky D, et al. Derivation and validation of a prognostic model for pulmonary embolism. American Journal of Respiratory and Critical Care Medicine. 2005 Oct 15;172(8):1041-1046.