PESI & sPESI Calculator for Pulmonary Embolism
Calculate original PESI and independently validated simplified PESI after confirmed acute pulmonary embolism from direct vital signs and source-defined clinical factors.
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About
PESI stands for Pulmonary Embolism Severity Index. This PESI & sPESI calculator uses initial observed values after confirmed acute pulmonary embolism in adults. Full mode calculates the original 11-predictor PESI and the independently validated six-factor simplified PESI from one record. sPESI-only mode needs no sex, respiratory rate, temperature, or mental-status input. [1, 2]
Both models stratify short-term prognosis, principally 30-day all-cause mortality. They are not tests for whether PE is present. Every required field must be answered: the web calculator does not apply retrospective missing-as-normal data handling.
Formula
Interpretation
Historical Aujesky 2005 cohort observations
30-day all-cause mortality, not an individual forecast. Differences between cohorts are material; no single percentage is “your risk.” [1]
| Class / source label | Score | Derivation | Internal validation | External validation |
|---|---|---|---|---|
| I — Very low risk | ≤65 | 1.1% | 1.6% | 0% |
| II — Low risk | 66–85 | 3.1% | 3.5% | 1.7% |
| III — Intermediate risk | 86–105 | 6.5% | 7.1% | 3.2% |
| IV — High risk | 106–125 | 10.4% | 11.4% | 4.0% |
| V — Very high risk | ≥126 | 24.5% | 23.9% | 10.0% |
Historical Jiménez 2010 sPESI cohorts
30-day mortality observations with 95% confidence intervals, not patient-level probabilities. [2]
| sPESI | Derivation (995) | RIETE validation (7,106) |
|---|---|---|
| 0 — Low | 1.0% (95% CI 0.0–2.1) | 1.1% (95% CI 0.7–1.5) |
| ≥1 — High | 10.9% (95% CI 8.5–13.2) | 8.9% (95% CI 8.1–9.8) |
PESI / sPESI in the 2026 AHA/ACC acute PE framework
PESI ≤85 (classes I–II) and sPESI 0 are examples of a low clinical-severity score component. PESI >85 (classes III–V) and sPESI ≥1 are elevated components. The full AHA/ACC A–E category cannot be calculated from PESI/sPESI alone: symptoms, hemodynamics, cardiopulmonary failure, biomarkers, RV imaging, and respiratory findings also matter. No category B/C, subcategory, or respiratory modifier is assigned here. [3]
The 2026 guideline has a published correction. This page does not attribute a change in PESI/sPESI thresholds to that correction. [4]
A low score is not outpatient clearance
Current guidance considers Hestia, PESI, and sPESI among outpatient decision tools. Prospective PESI outpatient studies also used additional Hestia-like exclusions, so their safety findings cannot be attributed to PESI alone. Clinical stability, access to anticoagulants, rapid reliable expert follow-up, treatment feasibility, support, and contraindications remain outside this calculator. Hemodynamic deterioration must not be dismissed because of a static score. This tool does not determine discharge, admission, ICU care, monitoring, thrombolysis, or other therapy. [3]
PESI/sPESI vs PE diagnostic tools
Wells PE estimates pretest probability in suspected PE. PERC is a conditional rule-out framework after low probability is independently established. YEARS combines clinical items and D-dimer in a separate diagnostic-management algorithm. PESI/sPESI assess prognosis after diagnosis; none is a substitute for the others. [3]
Hestia is a separate outpatient exclusion framework. Bova uses different prognostic inputs, including cardiac biomarkers and RV findings; CPES is a separate shock/severity framework. NEWS2 assesses general physiological deterioration and is not a PESI substitute. None is calculated or inferred here. [3]
Why can PESI and sPESI disagree?
These are separate validated models, not interchangeable displays. With all other factors absent, an 80-year-old male has PESI 90 (Class III) but sPESI 0 (Low); an 81-year-old female has PESI 81 (Class II) but sPESI 1 (High). The calculator neither averages the models nor chooses the more reassuring result. [1, 2]
PESI has no fixed maximum because age contributes its value without a model age ceiling. The sPESI maximum is six. Blank data are never filled in as normal.
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;172(8):1041–1046. PMID 16020800. PMCID PMC2718410. DOI 10.1164/rccm.200506-862OC.
- 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):1383–1389. PMID 20696966. DOI 10.1001/archinternmed.2010.199.
- Creager MA, Barnes GD, Giri J, et al. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults. Circulation. 2026;153:e977–e1051. PMID 41712677. DOI 10.1161/CIR.0000000000001415.
- Creager MA, Barnes GD, Giri J, et al. Correction to the 2026 Acute Pulmonary Embolism Guideline. Circulation. 2026;154(2):e24. PMID 42441758. DOI 10.1161/CIR.0000000000001462.
FAQ
PESI is the Pulmonary Embolism Severity Index: the original 2005 model has 11 predictors and five classes. The 2010 simplified PESI has six one-point factors (0–6). They are independently validated models for prognosis after acute PE, not interchangeable scores. Full mode computes both from a shared record; sPESI-only mode does not fill in missing PESI-only data.
PESI uses age, male sex, cancer, heart failure, chronic lung disease, pulse, systolic BP, respiratory rate, temperature, altered mental status, and oxygen saturation. sPESI uses age >80, cancer, heart failure OR chronic lung disease, pulse ≥110/min, SBP <100 mmHg, and oxygen saturation <90%.
No. The original PESI oxygen-saturation predictor was applied with and without supplemental oxygen. Use the recorded assessment value; this calculator does not reconstruct a room-air value or add oxygen-treatment points.
Sources: [1]
The original definition is disorientation, lethargy, stupor, or coma. It is not the NEWS2 new-confusion rule or the AIMS65 GCS threshold. This factor contributes 60 points only to full PESI, not sPESI.
Sources: [1]
No. PESI ≤85 and sPESI 0 are low clinical-severity score components in the 2026 framework, not complete AHA/ACC categories. Prospective PESI outpatient studies also used Hestia-like exclusions. Clinical stability, treatment access, rapid expert follow-up, social support and other findings remain necessary. No score here independently chooses discharge, admission, ICU care or thrombolysis.
Sources: [3]
No. Wells and PERC concern suspected PE. PESI/sPESI assess prognosis after confirmed PE. Hestia is an outpatient exclusion framework, Bova uses different PE prognostic inputs, and NEWS2 assesses general physiological deterioration. These tools and YEARS/CPES remain separate; none is calculated from a PESI result.
Sources: [3]
Related Calculators
Wells PE
Calculate the seven-criterion Wells score for pulmonary embolism with modified two-level and standard three-level classifications.
PERC Rule
Check all eight PERC criteria for a low-probability adult suspected-PE assessment, with exact age, pulse, room-air oxygen, history, and examination boundaries.
NEWS2 Score
Calculate the current RCP NEWS2 adult acute-illness score from a complete observation set, including the correct SpO₂ scale, oxygen uplift, red-score components, and trigger category.
Disclaimer
Educational and informational reference only. Not intended to replace professional medical advice, diagnosis, treatment, or independent verification.