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PESI and simplified PESI (sPESI)

Also called Pulmonary Embolism Severity Index, sPESI, PE severity

30-day mortality risk in acute pulmonary embolism; identifies low-risk patients for early discharge.

years
Sex

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Formula and scoring

PESI = age + 10 (male) + cancer 30 + HF 10 + chronic lung disease 10 + HR ≥110 20 + SBP <100 30 + RR ≥30 20 + T <36 °C 20 + AMS 60 + SaO₂ <90% 20. Classes ≤65 / 66–85 / 86–105 / 106–125 / >125. sPESI: 1 each for age >80, cancer, chronic cardiopulmonary disease, HR ≥110, SBP <100, SaO₂ <90%.

Exam and ward pearls

  • PESI class I–II or sPESI 0 defines the clinically low-risk group in the ESC 2019 PE guideline.
  • Altered mental status carries the largest weight (+60).

When not to rely on it

  • Not for haemodynamically unstable (high-risk) PE; that group is defined by shock, not by PESI.
  • ESC 2019 prints RR ">30"; the original derivation used ≥30, which is used here.

Source

  1. Aujesky D, Obrosky DS, Stone RA, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005;172(8):1041-6. doi:10.1164/rccm.200506-862OC · PMID 16020800
  2. Jiménez D, Aujesky D, Moores L, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010;170(15):1383-9. doi:10.1001/archinternmed.2010.199 · PMID 20696966
  3. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2020;41(4):543-603. doi:10.1093/eurheartj/ehz405 · PMID 31504429

Formula and cut-offs checked against these sources on 8 Nov 2026. Educational tool for clinicians; it does not replace clinical judgement.

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