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BackTable / VI / Tool
PESI Score
The Pulmonary Embolism Severity Index (PESI) Score is a clinical risk stratification tool used to estimate 30-day mortality in patients diagnosed with pulmonary embolism (PE). It helps physicians quickly categorize patients into five risk classes based on clinical findings and comorbidities, including age, vital signs, and preexisting conditions like cancer or heart failure. By identifying low-risk patients, the PESI Score supports decisions about whether outpatient management is appropriate, while higher scores suggest a need for closer monitoring or inpatient care.
Originally developed and validated in large cohorts, the PESI Score has been widely adopted in emergency medicine, internal medicine, and pulmonology as part of evidence-based PE protocols. Its value lies in standardizing the initial risk assessment and improving patient outcomes through more tailored interventions. This page includes a PESI Score calculator and guidance on score interpretation to assist with bedside decision-making and documentation.
PESI Score
Age
Sex
History of cancer
History of heart failure
History of chronic lung disease
Heart rate ≥ 110 bpm
Systolic BP < 100 mmHg
Respiratory rate ≥ 30 breaths/min
Temperature < 36°C (96.8°F)
Altered mental status (disorientation, lethargy, stupor, or coma)
Arterial oxygen saturation < 90%
Value
Description
PESI Scoring & Interpretation
The PESI Score is based on 11 clinical variables, each assigned a weighted point value. The total score places patients into five risk classes predicting 30-day mortality. The variables are:
1. Age: 1 point per year
2. Male sex: +10 points
3. History of cancer: +30 points
4. History of heart failure: +10 points
5. History of chronic lung disease: +10 points
6. Heart rate ≥110 bpm: +20 points
7. Systolic blood pressure <100 mmHg: +30 points
8. Respiratory rate ≥30 breaths/min: +20 points
9. Temperature <36°C: +20 points
10. Altered mental status (disorientation, lethargy, stupor, or coma): +60 points
11. Arterial oxygen saturation <90%: +20 points
Based on the total score, patients are stratified into the following risk classes:
• Class I (≤65 points): Very low risk – 0.0 - 1.6% 30-day mortality
• Class II (66–85 points): Low risk – 1.7 - 3.5% 30-day mortality
• Class III (86–105 points): Intermediate risk – 3.2 - 7.1% 30-day mortality
• Class IV (106–125 points): High risk – 4.0 - 11.4% 30-day mortality
• Class V (>125 points): Very high risk – 10.0 - 24.5% 30-day mortality
Patients in Classes I and II may be eligible for outpatient management, while Classes III through V usually require inpatient evaluation and treatment.
Limitations of the PESI Score
While PESI is widely validated, it has limitations. It may underestimate risk in younger patients with abnormal vital signs or overestimate risk in older patients due to age-weighting. It also does not include biomarkers such as troponin or imaging findings, which may offer additional prognostic value. In cases where other clinical features raise concern, PESI should be considered as one part of a broader clinical judgment process.
Learn more on the BackTable VI Podcast
BackTable is a knowledge resource for physicians by physicians. Get practical advice on the PESI Score and how to build your practice by listening to the BackTable Podcast.
References
[1] Aujesky, D., Obrosky, D. S., Stone, R. A., et al. "Derivation and validation of a prognostic model for pulmonary embolism." American Journal of Respiratory and Critical Care Medicine, 2005;172(8):1041–1046.
[2] Donadini, M. P., Dentali, F., Riva, N., et al. "Pulmonary embolism severity index accurately predicts long-term mortality in patients with acute pulmonary embolism." Thrombosis Research, 2012;130(5):541–544.
[3] Jiménez, D., Aujesky, D., Moores, L., et al. "Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism." Archives of Internal Medicine, 2010;170(15):1383–1389.
[4] Zondag, W., Mos, I. C., Creemers-Schild, D., et al. "Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study." Journal of Thrombosis and Haemostasis, 2011;9(8):1500–1507.
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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