sPESI (Simplified Pulmonary Embolism Severity Index)
30-day mortality estimate in confirmed pulmonary embolism, used to decide between outpatient and inpatient management.
About this calculator
sPESI (Simplified Pulmonary Embolism Severity Index) is the simplified PE severity score. Developed by Jiménez et al. (Arch Intern Med, 2010) as a simplification of the original PESI. Six criteria, 1 point each: age >80, cancer history, chronic cardiac or pulmonary disease, heart rate >=110, systolic BP <100, SpO2 <90%. Interpretation. 0 points – low risk, 30-day mortality 1%. >=1 – high risk, 30-day mortality 10.9%, admission required. Clinical use. ESC 2019 and AHA/CHEST 2024 recommend sPESI as the primary stratification tool after PE diagnosis. Patients with sPESI=0 without RV dysfunction on echo and without troponin elevation are candidates for outpatient management (HOSP-PE, HoT-PE trials). Therapy – DOACs (apixaban, rivaroxaban, edoxaban with prior heparin, dabigatran after 5-10 days of heparin). Intermediate risk. sPESI >=1 plus elevated troponin and/or RV dysfunction – intermediate risk; admission to monitored bed. Thrombolysis is decided individually – PEITHO showed benefit only with hemodynamic instability or high decompensation risk. High risk. Shock or hypotension (systolic BP <90 for 15 minutes not from hypovolemia, sepsis, arrhythmia) – outside sPESI; classified as massive PE. Systemic thrombolysis with alteplase (100 mg over 2 hours) or catheter-directed therapy at major PE centers indicated. Limitations. Does not include echo or troponin – their addition improves discrimination (modified Hestia, Bova indices). Does not predict bleeding from anticoagulation – use RIETE bleeding score. In pregnancy and cancer sPESI performs worse – adapted scores and individual assessment apply.
Source
Formula version: jimenez-2010-esc-2019-v1