PESI v.1
Pulmonary embolism severity index (PESI) is a risk-scoring system used to predict the 30-day outcome (mortality and long-term morbidity) in individuals with pulmonary embolism (PE) using 11 non-laboratory based characteristics; including 2 demographic (age, male sex), 3 comorbid (cancer, heart failure, chronic lung disease) and 6 clinical (pulse ⩾ 110/min, systolic blood pressure < 100 mmHg, respiratory rate ⩾ 30/min, temperature < 36°C, altered mental status [disorientation, lethargy, stupor, or coma], arterial oxygen saturation < 90%). Points are assigned based on the presence of each characteristic and the sum of the 11 points assigned is used to categorize patients into risk classes: class I (score 0 - 65) is very low risk, class II (66 - 85) is low risk, class III (86 - 105) is intermediate risk, class IV (106 - 125) is high risk and class V (> 125) is very high risk. These classes correspond to 30-day mortality of 0.0-1.6%, 1.7-3.5%, 3.2-7.1%, 4.0-11.4% and 10.0-24.5% respectively. PESI has been internally and externally validated as having high sensitivity for predicting mortality and reliably identifies patients with PE who are at low risk of death and who are potential candidates for outpatient care.
To predict 30-day mortality in patients with pulmonary embolism, and help distinguish between low-risk individuals who are potential candidates for out-patient care and high-risk patients who require high dependency/intensive care.
To calculate the pulmonary embolism severity index using the following 11 variables: - demographic characteristics (age = +age in years; male sex = +10) - comorbidities (cancer = +30; heart failure = +10; chronic lung disease = +10) - clinical findings (pulse ⩾ 110/min = +20; systolic blood pressure < 100 mmHg = +30; respiratory rate ⩾ 30/min = +20; temperature < 36°C = +20; altered mental status [disorientation, lethargy, stupor, or coma] = +60; arterial oxygen saturation < 90% =+20). Absence of any characteristic => score of 0 (zero). The sum of the 11 points assigned is used to categorize patients into risk classes: CLASS SCORE RISK LEVEL 30-day MORTALITY Class I ≤ 65 Very low risk 0.0-1.6% Class II 66-85 Low risk 1.7-3.5% Class III 86-105 Intermediate risk 3.2-7.1% Class IV 106-125 High risk 4.0-11.4% Class V >125 Very high risk 10-24.5% Risk level and 30-day mortality are evaluated using a separate PESI_Assessment application.
Not to be used to make a diagnosis of pulmonary embolism, as PESI is only meant for risk stratification of pulmonary embolism after the diagnosis has been made.
Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, Roy PM, Fine MJ. Derivation and validation of a prognostic model for pulmonary embolism. American journal of respiratory and critical care medicine. 2005 Oct 15;172(8):1041-6. Donzé J, Le Gal G, Fine MJ, Roy PM, Sanchez O, Verschuren F, Cornuz J, Meyer G, Perrier A, Righini M, Aujesky D. Prospective validation of the Pulmonary Embolism Severity Index-A clinical prognostic model for pulmonary embolism. Thrombosis and haemostasis. 2008;100(5):943-8. Fraga M, Taffé P, Méan M, Hugli O, Witzig S, Waeber G, Aujesky D. The inter-rater reliability of the Pulmonary Embolism Severity Index. Thrombosis & Haemostasis. 2010 Dec 10;104(6):1258.
OBSERVATION.basic_demographic.v1, OBSERVATION.history_prior_medical_diagnosis.v1, OBSERVATION.pulse.v2, OBSERVATION.blood_pressure.v2, OBSERVATION.respiration.v2, OBSERVATION.body_temperature.v2, OBSERVATION.indirect_oximetry.v1, OBSERVATION.pulmonary_embolism_severity_index.v1, EVALUATION.pulmonary_embolism_severity_index.v1
