PESI Score Calculator

PESI Score Calculator for Pulmonology. Original PESI classes carry escalating 30-day mortality: Class I (<=65 points) 0-1.6%, Class II (66-85) 1.7-3.5%, Class III (86-105) 3.2-7.1%, Class IV (106-125) 4.0-11.4%, and Class V (>125) 10.0-24.5%. Classes I-II define low risk and identify patients who may be considered for outpatient management, while Classes III-V mark higher-risk patients warranting hospitalization. With sPESI, a score of 0 (no positive items) indicates low risk with roughly 1% mortality, and any score >=1 indicates elevated risk. The tool's strength is its high negative predictive value for ruling out early death, not for precisely predicting who will die.

How this calculator works

The Pulmonary Embolism Severity Index estimates 30-day all-cause mortality risk after acute PE using 11 routinely available clinical variables. Points are added to a baseline equal to the patient's age in years: male sex (+10), cancer (+30), heart failure (+10), chronic lung disease (+10), pulse >=110/min (+20), systolic BP <100 mmHg (+30), respiratory rate >=30/min (+20), temperature <36 C (+20), altered mental status (+60), and arterial oxygen saturation <90% (+20). The total maps to five severity classes (I-V). A simplified version (sPESI) collapses these into six equally weighted binary items, where any score >=1 flags high risk.

When to use this calculator

Apply PESI or sPESI to normotensive patients with objectively confirmed acute symptomatic PE, ideally at the point of diagnosis, to stratify early mortality risk and identify candidates for outpatient or early-discharge management versus those needing monitored inpatient care. It is endorsed for this purpose by the 2019 ESC guidelines. It should not be used to guide reperfusion decisions in hemodynamically unstable (high-risk) PE, where shock or persistent hypotension already defines the highest-risk group, nor as a standalone tool to select intermediate-high-risk patients, who additionally require RV imaging and cardiac biomarkers.

Inputs used

  • Age
  • Sex
  • Cancer
  • Heart failure
  • Chronic lung disease
  • Pulse
  • Systolic blood pressure
  • Respiratory rate
  • Temperature
  • Mental status
  • Oxygen saturation

Clinical interpretation

Original PESI classes carry escalating 30-day mortality: Class I (<=65 points) 0-1.6%, Class II (66-85) 1.7-3.5%, Class III (86-105) 3.2-7.1%, Class IV (106-125) 4.0-11.4%, and Class V (>125) 10.0-24.5%. Classes I-II define low risk and identify patients who may be considered for outpatient management, while Classes III-V mark higher-risk patients warranting hospitalization. With sPESI, a score of 0 (no positive items) indicates low risk with roughly 1% mortality, and any score >=1 indicates elevated risk. The tool's strength is its high negative predictive value for ruling out early death, not for precisely predicting who will die.

Worked example

A 68-year-old man with active lung cancer, heart rate 96, systolic BP 128 mmHg, respiratory rate 22, temperature 37 C, normal mentation, and SaO2 94%. Score = 68 (age) + 10 (male) + 30 (cancer) = 108 points. This places him in Class III (106-125), an intermediate-risk category with roughly 3-7% 30-day mortality, so inpatient observation rather than outpatient treatment is appropriate despite normal vital signs.

Limitations and safety notes

PESI predicts 30-day all-cause mortality, not PE-specific death, so a high score in an elderly patient with cancer partly reflects competing comorbidity rather than PE severity. It does not incorporate right ventricular dysfunction or cardiac biomarkers, so a low-risk score cannot by itself exclude intermediate-high-risk PE; the ESC pathway pairs a low sPESI/PESI with troponin and RV assessment before outpatient decisions. It was derived and validated largely in inpatients and is not intended for hemodynamically unstable PE. Age dominates the original score, which can misclassify young patients with genuinely severe PE as low class.

Frequently asked questions

What is the difference between PESI and simplified PESI (sPESI)?

The original PESI uses 11 weighted variables and produces five severity classes. The sPESI reduces this to six equally weighted binary criteria (age >80, cancer, chronic cardiopulmonary disease, heart rate >=110, systolic BP <100, and SaO2 <90%). Any single positive item makes sPESI >=1 and classifies the patient as high risk; a score of 0 is low risk. Both have comparable prognostic accuracy, and sPESI is easier to apply at the bedside.

Can a low PESI score be used to send a patient home?

A low-risk PESI (Class I-II) or sPESI of 0 identifies candidates potentially suitable for outpatient or early-discharge treatment, and this is supported by the ESC guidelines. However, low risk should be confirmed alongside adequate home circumstances, absence of severe symptoms or renal/bleeding concerns, and, in many pathways, reassuring RV imaging and normal cardiac biomarkers before discharge.

Does PESI account for right ventricular strain or troponin?

No. PESI and sPESI use only clinical variables and vital signs. They do not include echocardiographic or CT signs of RV dysfunction, or biomarkers such as troponin and BNP. This is why intermediate-risk PE stratification in current guidelines combines a PESI Class III-V or sPESI >=1 with imaging and biomarker findings.

Which patients should not be assessed with PESI?

PESI is intended for normotensive patients with confirmed acute PE. It should not be applied to hemodynamically unstable patients with shock or persistent hypotension, who are already classified as high-risk PE and require consideration of reperfusion therapy regardless of the score.

References

  • 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. PMID: 16020800.
  • Jimenez 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. PMID: 20696966.
  • Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020. PMID: 31504429.

Editorial review and citation methodology

Reviewed by the Quick Medical Calculator Editorial Team. Last reviewed: April 8, 2026. The review checks calculator inputs, intended population, interpretation, limitations, and source alignment.

  • Prefer original validation studies for scoring systems and prediction tools.
  • Use current specialty society guidance, transplant allocation policy, public health guidance, or regulator resources when they govern clinical use.
  • Include limitations and safety notes when a calculator is population-specific, context-dependent, or unsuitable as a standalone decision tool.

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