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Instructions

Use PESI only for risk stratification after the diagnosis of Pulmonary Embolism (PE) has been made.
Patients with renal failure or severe comorbidities were excluded from the validation study.
The PESI score aids in the assessment of clinical severity and can may help guide the treatment setting for management of PE.
Clinical judgement and best practice guidelines (e.g. 2026 AHA Guideline for the Evaluation and Management of Acute PE in Adults) supersedes adjunct standalone decision tools.

Age

Min 0 – Max 120

The PESI is a validated clinical prediction rule that estimates 30-day all-cause mortality in patients with confirmed acute pulmonary embolism. The PESI score aids in the assessment of clinical severity and can may help guide the treatment setting for management of PE. It was developed by Aujesky and colleagues in 2005, derived from over 15,000 patients and externally validated, and unlike some newer scores it estimates prognosis rather than diagnosing PE — it's typically used alongside diagnostic tools like the Wells score or revised Geneva score, which address whether PE is present at all.

Use PESI only for risk stratification after the diagnosis of Pulmonary Embolism (PE) has been made.
Patients with renal failure or severe comorbidities were excluded from the validation study. Clinical judgement ought to be used over the PESI.

Scoring

The score sums the patient's age in years with points for 10 additional variables when present:

Predictor	Points
Age	+1 per year
Male sex	+10
Cancer (active/history)	+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
Arterial oxygen saturation < 90%	+20

Risk Classes and 30-Day Mortality

Total Points	Class	Risk	30-Day Mortality
≤65	I	Very low	0–1.6%
66–85	II	Low	1.7–3.5%
86–105	III	Intermediate	3.2–7.1%
106–125	IV	High	4.0–11.4%
>125	V	Very high	10.0–24.5%

Classes I and II are generally considered low risk, and in a stable, non-pregnant patient, these classes may be appropriate for outpatient management depending on local protocols.

Simplified PESI (sPESI)

A simplified version condenses this to six yes/no variables, each worth 1 point: age >80, cancer, chronic cardiopulmonary disease, heart rate ≥110, systolic BP <100 mmHg, and oxygen saturation <90%. A score of 0 indicates low risk (30-day mortality ~1.0%), while any point (≥1) indicates high risk (~10.9% mortality). The sPESI is easier to apply at the bedside, though it hasn't been as independently validated as the original PESI.

Reliability

Inter-rater reliability studies found near-perfect agreement between different clinicians calculating the score — with reliability coefficients above 0.60 for 10 of the 11 individual variables and near-perfect agreement (ICC 0.89) on the total score and risk classification, supporting its reproducibility in routine practice.

Note: As with the RIETE score, PESI is a decision-support tool meant to complement — not replace — overall clinical judgment, particularly given some subjectivity in variables like "altered mental status."

Clinical Considerations & Recommendations

Class	Recommendation
I & II	The overall risk of mortality or severe morbidity is low. If clinically appropriate and social factors (e.g. access to anticoagulants and prompt follow-up care, typically within 7 days) are conducive, consider outpatient management in the right clinical setting. Consider additional pathology that may contribute to morbidity or mortality before considering outpatient management.
III, IV, V	The overall risk of mortality or severe morbidity is high. For patients with higher scores, consider higher levels of care (e.g. ICU).

Note:

Renal failure or patients with other significant comorbidities should be considered separately as these patients were not included in the validation study.
Pro-BNP levels, RV function, and the presence of right-heart thrombus may also affect a patient's risk assessment.
Clinical judgement and best practice guidelines (e.g. 2026 AHA Guideline for the Evaluation and Management of Acute PE in Adults) supersedes adjunct standalone decision tools.

All questions & possible results

Patient DetailsTitle not visible

Age

A number between 0 and 120 (whole numbers), in years.

Sex

Select one option:

Male
Female

History of cancer

Select one option:

History of heart failure

Select one option:

History of chronic lung disease

Select one option:

Heart rate ≥110

Select one option:

Systolic BP <100 mmHg

Select one option:

Respiratory rate ≥30

Select one option:

Temperature <36°C/96.8°F

Select one option:

Altered mental status

Disorientation, lethargy, stupor, or coma

Select one option:

O2 saturation <90%

Select one option:

Possible results

Low Risk (Class II): Scores of 66-85

1.7-3.5% risk of 30 day mortality. In the first validation, low risk (Class I and II) had a 90-day mortality of 1.1%. The overall risk of mortality or severe morbidity is low.
If clinically appropriate and social factors (e.g. access to anticoagulants and prompt follow-up care, typically within 7 days) are conducive, consider outpatient management in the right clinical setting.
Consider additional pathology that may contribute to morbidity or mortality before considering outpatient management.
Clinical judgement and best practice guidelines (e.g. 2026 AHA Guideline for the Evaluation and Management of Acute PE in Adults) supersedes adjunct standalone decision tools..

Note:

Renal failure or patients with other significant comorbidities should be considered separately as these patients were not included in the validation study.
Pro-BNP levels, RV function, and the presence of right-heart thrombus may also affect a patient's risk assessment.

Intermediate Risk (Class III): Scores of 86-105

3.2-7.1% risk of 30 day mortality. The overall risk of mortality or severe morbidity is high.
For patients with higher scores, consider higher levels of care (e.g. ICU)
Consider additional pathology that may contribute to morbidity or mortality before considering outpatient management.
Renal failure or patients with other significant comorbidities should be considered separately as these patients were not included in the validation study.
Pro-BNP levels, RV function, and the presence of right-heart thrombus may also affect a patient's risk assessment.
Clinical judgement and best practice guidelines (e.g. 2026 AHA Guideline for the Evaluation and Management of Acute PE in Adults) supersedes adjunct standalone decision tools.

High Risk (Class IV): Scores of 106-125

4.0-11.4% risk of 30 day mortality. The overall risk of mortality or severe morbidity is high.
For patients with higher scores, consider higher levels of care (e.g. ICU).
Consider additional pathology that may contribute to morbidity or mortality before considering outpatient management.
Renal failure or patients with other significant comorbidities should be considered separately as these patients were not included in the validation study.
Pro-BNP levels, RV function, and the presence of right-heart thrombus may also affect a patient's risk assessment.
Clinical judgement and best practice guidelines (e.g. 2026 AHA Guideline for the Evaluation and Management of Acute PE in Adults) supersedes adjunct standalone decision tools.

Very High Risk (Class V): Scores > 125

10-24.5% risk of 30 day mortality. The overall risk of mortality or severe morbidity is high.
For patients with higher scores, consider higher levels of care (e.g. ICU).
Consider additional pathology that may contribute to morbidity or mortality before considering outpatient management.
Renal failure or patients with other significant comorbidities should be considered separately as these patients were not included in the validation study.
Pro-BNP levels, RV function, and the presence of right-heart thrombus may also affect a patient's risk assessment.
Clinical judgement and best practice guidelines (e.g. 2026 AHA Guideline for the Evaluation and Management of Acute PE in Adults) supersedes adjunct standalone decision tools.

Very Low Risk (Class I): Scores ≤ 65

For those determined to be very low risk (score ≤ 65), all studies showed a 30-day mortality of <2%.
In the first validation, low risk (Class I and II) had a 90-day mortality of 1.1%. The overall risk of mortality or severe morbidity is low.
If clinically appropriate and social factors (e.g. access to anticoagulants and prompt follow-up care, typically within 7 days) are conducive, consider outpatient management in the right clinical setting.
Consider additional pathology that may contribute to morbidity or mortality before considering outpatient management.
Clinical judgement and best practice guidelines (e.g. 2026 AHA Guideline for the Evaluation and Management of Acute PE in Adults) supersedes adjunct standalone decision tools.

Note:

Renal failure or patients with other significant comorbidities should be considered separately as these patients were not included in the validation study.
Pro-BNP levels, RV function, and the presence of right-heart thrombus may also affect a patient's risk assessment.

Citation

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. Am J Respir Crit Care Med. 2005 Oct 15;172(8):1041-6. doi: 10.1164/rccm.200506-862OC. Epub 2005 Jul 14.

Literature

Derivation and validation of a prognostic model for pulmonary embolism
Drahomir Aujesky 1, D Scott Obrosky, Roslyn A Stone, Thomas E Auble, Arnaud Perrier, Jacques Cornuz, Pierre-Marie Roy, Michael J Fine
https://pubmed.ncbi.nlm.nih.gov/16020800/
Prospective validation of the Pulmonary Embolism Severity Index. A clinical prognostic model for pulmonary embolism
Jacques Donzé 1, Grégoire Le Gal, Michael J Fine, Pierre-Marie Roy, Olivier Sanchez, Franck Verschuren, Jacques Cornuz, Guy Meyer, Arnaud Perrier, Marc Righini, Drahomir Aujesky
https://pubmed.ncbi.nlm.nih.gov/18989542/
Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial
Drahomir Aujesky 1, Pierre-Marie Roy, Franck Verschuren, Marc Righini, Joseph Osterwalder, Michael Egloff, Bertrand Renaud, Peter Verhamme, Roslyn A Stone, Catherine Legall, Olivier Sanchez, Nathan A Pugh, Alfred N'gako, Jacques Cornuz, Olivier Hugli, Hans-Jürg Beer, Arnaud Perrier, Michael J Fine, Donald M Yealy
https://pubmed.ncbi.nlm.nih.gov/21703676/
2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026 Mar 24;153(12):e977-e1051. doi: 10.1161/CIR.0000000000001415. Epub 2026 Feb 19. Erratum in: Circulation. 2026 Jul 14;154(2):e24.
Writing Committee Members; Creager MA, Barnes GD, Giri J, Mukherjee D, Jones WS, Burnett AE, Carman T, Casanegra AI, Castellucci LA, Clark SM, Cushman M, de Wit K, Eaves JM, Fang MC, Goldberg JB, Henkin S, Johnston-Cox H, Kadavath S, Kadian-Dodov D, Keeling WB, Klein AJP, Li J, McDaniel MC, Moores LK, Piazza G, Prenger KS, Pugliese SC, Ranade M, Rosovsky RP, Russo F, Secemsky EA, Sista AK, Tefera L, Weinberg I, Westafer LM, Young MN.
https://pubmed.ncbi.nlm.nih.gov/41712677/

All questions & possible results

Citation

Literature

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