Thrombosis & Bleeding

Pulmonary Embolism Severity Index (PESI) Calculator

Predicts 30-day mortality in confirmed acute pulmonary embolism, in five risk classes.

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

Turn on JavaScript to use this calculator, or open it in the web app.

Formula

PESI = age in years + points for each finding
Male sex +10
Cancer +30
Heart failure +10
Chronic lung disease +10
Pulse ≥110/min +20
Systolic BP <100 mm Hg +30
Respiratory rate ≥30/min +20
Temperature <36 °C +20
Altered mental status (disorientation, lethargy, stupor or coma) +60
Arterial O₂ saturation <90% +20
Class I ≤65, II 66–85, III 86–105, IV 106–125, V >125

How it is used

• Class I–II is low-risk PE when there is no RV dysfunction on echo or CT and no raised troponin (if checked): carefully selected patients can be considered for early discharge and home anticoagulation (ESC 2019).
• Class III–V is at least intermediate risk: check the RV (echo or CT) and troponin; intermediate-high risk patients (both abnormal) are monitored for decompensation and rescue reperfusion (ESC 2019).
• Built to predict outcome once acute PE is confirmed, not to diagnose it (Aujesky 2005). Shock or persistent hypotension is high-risk PE whatever the score (ESC 2019).
• The simplified PESI (sPESI) gives similar accuracy with six items (Jiménez 2010).

Key points

• A low class does not outweigh RV dysfunction, a raised troponin or clinical deterioration: such patients are intermediate risk (ESC 2019).

Same formula as the app. Open it in the web app.

Related one-pagers

• Pulmonary EmbolismLow · A, B · A: incidental. B: PESI I–II or sPESI 0
• Bleeding, Reversal, HIT and DIC

Related calculators

• Bleeding Risk on Anticoagulation (HAS-BLED)
• Caprini VTE Risk Score for Surgery (Caprini)
• Heparin-Induced Thrombocytopenia Probability (4Ts)
• Padua Prediction Score for VTE (Padua)
• Simplified PESI (sPESI)
• Stroke Risk in Atrial Fibrillation (CHA₂DS₂-VASc)
• Wells Score for PE (Wells)

For education and exam preparation only. Follow your institution’s protocols. For education and exam preparation only. Verify results independently and follow your institution’s protocols. Not a substitute for clinical judgment.