sPESI Score Calculator for Pulmonary Embolism Prognosis
The simplified Pulmonary Embolism Severity Index (sPESI) is a validated clinical tool that predicts 30-day mortality in patients with acute pulmonary embolism (PE), helping guide the decision between outpatient versus inpatient management.
About
The simplified Pulmonary Embolism Severity Index (sPESI) was derived and validated from the original PESI by Jiménez et al. and published in the Annals of Internal Medicine in 2010. It uses six binary variables, each scoring 1 point: age >80 years, history of cancer (active or treated within the last year), chronic cardiopulmonary disease (CHF or chronic lung disease), heart rate ≥110 bpm, systolic BP <100 mmHg, and oxygen saturation <90% on room air. Total score ranges 0-6. A score of 0 identifies low-risk patients (30-day mortality 1%) who may be candidates for early discharge or outpatient management. A score ≥1 indicates high risk (30-day mortality 10.9%) requiring hospital admission. sPESI is recommended by the ESC guidelines for initial risk stratification of acute PE.
Formula
Age >80 (1) + Cancer (1) + Chronic Cardiopulmonary Disease (1) + HR ≥110 (1) + SBP <100 (1) + SpO₂ <90% (1)
The sPESI score is calculated by summing 1 point for each of six binary variables present at the time of PE diagnosis. Age >80 years reflects limited physiologic reserve. Cancer identifies patients with hypercoagulability and limited survival. Chronic cardiopulmonary disease (CHF or chronic lung disease) indicates reduced cardiac or pulmonary reserve. Tachycardia ≥110 bpm and hypotension SBP <100 mmHg suggest hemodynamic compromise. Hypoxia SpO₂ <90% indicates significant gas exchange impairment. Total score 0 (low risk, 30-day mortality 1%) or ≥1 (high risk, 30-day mortality 10.9%).
Score Interpretation
sPESI is the most widely used simplified risk score for acute PE and is formally recommended by the 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. A score of 0 (low risk) identifies approximately 30-40% of PE patients who may be eligible for early discharge or outpatient management, reducing healthcare costs and improving patient satisfaction without increasing adverse events. The original PESI has 11 variables with complex scoring, while sPESI with only 6 binary variables offers equivalent prognostic accuracy with greater clinical utility. sPESI has been validated in multiple international cohorts including over 50,000 patients. Notably, sPESI has negative predictive value exceeding 98% for 30-day mortality in low-risk patients. The ESC guidelines recommend clinical risk assessment with sPESI (or PESI) followed by assessment of right ventricular function by echocardiography or CT to further refine risk classification.
Low Risk — Outpatient Candidate — 0–0
30-day mortality 1%. Suitable for early discharge or outpatient management if no other contraindications.
Management: Consider outpatient management. Anticoagulation with DOAC or LMWH as per guidelines. Early follow-up within 2-7 days.
High Risk — Inpatient Management — 1–6
30-day mortality 10.9%. Hospital admission indicated.
Management: Hospital admission. Initiate therapeutic anticoagulation. Consider echocardiography. Evaluate for thrombolysis if hemodynamic instability. Close monitoring.
Reference Ranges
| Population | Normal Range | Notes |
|---|---|---|
| Acute PE patients | 0-6 points | 0 = low risk (1% 30-day mortality); ≥1 = high risk (10.9% 30-day mortality) |
Dr. Khaled Hassan
Dr. Khaled is a cardiology consultant with experience in acute cardiac care.
View medical review board & editorial policy →Example Calculation
A 76-year-old woman with acute PE, HR 105 bpm, SBP 125 mmHg, SpO₂ 88%, no cancer, no CHF, no chronic lung disease. sPESI: age ≤80 (0) + no cancer (0) + no cardiopulmonary disease (0) + HR 105<110 (0) + SBP≥100 (0) + SpO₂ 88%<90 (1) = 1/6 — high risk, 30-day mortality 10.9%. Admit for anticoagulation.
Related Conditions
Related Medications
Common Mistakes
Using PESI when sPESI is quicker and equally validated
sPESI has equivalent prognostic accuracy to the full PESI and is simpler to use at bedside. Use sPESI for initial risk stratification.
Classifying hypoxia incorrectly
SpO₂ <90% on room air scores 1 point. If patient is on supplemental oxygen, document room air saturation before oxygen administration or note that the patient requires oxygen to maintain SpO₂ ≥90%.
Not counting CHF and chronic lung disease separately from other comorbidities
CHF or chronic lung disease is a single binary variable (1 point if either present). Do not double-count.
Frequently Asked Questions
What is the difference between PESI and sPESI?
Can sPESI be used for intermediate-risk PE?
What is the 30-day mortality for sPESI 0?
Is sPESI recommended by international guidelines?
References
- Jiménez D, Aujesky D, Moores L, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Ann Intern Med. 2010;153(7):433-441. PubMed
- Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2020;41(4):543-603. PubMed
- 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. PubMed