sPESI (Simplified Pulmonary Embolism Severity Index)
30-day mortality estimate in confirmed pulmonary embolism, used to decide between outpatient and inpatient management.
Updated · Methodology
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