Simplified PESI (sPESI)
The simplified Pulmonary Embolism Severity Index stratifies patients with confirmed PE into low-risk (sPESI 0) and higher-risk (sPESI ≥1) groups, primarily to identify candidates for outpatient management.
inputs
✓ when to use
Use AFTER PE is confirmed by imaging to guide disposition and treatment intensity. sPESI 0 identifies low-risk patients who may be candidates for outpatient treatment with anticoagulation alone. sPESI ≥1 patients generally require inpatient care and further risk stratification.
✗ when not to use
sPESI is a prognostic tool for confirmed PE, not a diagnostic tool. Do not use to determine whether to investigate for PE — use Wells PE, PERC, or YEARS for that purpose. Not validated in haemodynamically unstable (massive) PE — these patients require immediate reperfusion therapy regardless of score.
clinical pearls
- sPESI is used AFTER PE is diagnosed — it answers 'how sick is this patient?' not 'does this patient have PE?'. A common error is confusing prognostic scores (sPESI) with diagnostic scores (Wells PE).
- A sPESI of 0 is necessary but not sufficient for outpatient management. Also consider social circumstances, ability to comply with anticoagulation, access to follow-up, and patient preference. The Hestia criteria provide a more comprehensive outpatient eligibility checklist.
- For sPESI ≥1 patients, further risk stratification with RV assessment (echo or CT) and troponin helps identify the submassive (intermediate-high risk) group that may benefit from closer monitoring or advanced therapies.
- The age threshold in sPESI is >80, not ≥65. This is stricter than many clinical scores and means many elderly patients with PE will still score 0 if no other criteria are met.
- sPESI does not capture RV dysfunction, troponin elevation, or clinical gestalt — all of which are important in PE risk stratification. Use sPESI as a starting framework, not the final answer.