History of heart failure or chronic pulmonary disease
Heart rate ≥ 110/min
SBP < 100 mm Hg
O2 saturation < 90%
About this score
sPESI (simplified Pulmonary Embolism Severity Index) is a simplified version of PESI, proposed by D. Jiménez et al. (Arch Intern Med, 2010). It uses only 6 binary criteria, each worth 1 point: age > 80 years, active cancer, chronic cardiac or pulmonary disease, heart rate ≥ 110/min, SBP < 100 mm Hg, SaO2 < 90%.
Interpretation is two-tiered: 0 points indicates low risk (30-day mortality ~1%), ≥ 1 point indicates high risk (~10.9%). Its simplicity makes sPESI a practical tool for the "where should this patient go now" decision in the emergency department: patients with 0 points are considered candidates for outpatient treatment, an approach supported by large trials (HoT-PE, OTPE) and endorsed by the ESC 2019 guidelines.
In clinical practice, sPESI has largely replaced the full PESI score at the triage stage, with the full PESI now used mainly in research settings.
When to use
Confirmed PE — rapid risk stratification in the emergency department.
Deciding between outpatient treatment and hospitalization — a score of 0 supports discharge home when social circumstances allow.
Screening before escalation to chest CT or echocardiography in unstable patients.
Standard documentation of PE severity in the medical record.
Parameters in detail
Age > 80 years
Age older than 80 years, scores 1 point if present.
Active malignancy
History of active malignancy, scores 1 point if present.
History of heart failure or chronic pulmonary disease
Chronic heart failure or chronic pulmonary disease, scores 1 point if present. See FAQ for the definition used in the original validation study.
Heart rate ≥ 110/min
Heart rate 110 beats/min or higher, scores 1 point if present.
SBP < 100 mm Hg
Systolic blood pressure below 100 mm Hg, scores 1 point if present.
O2 saturation < 90%
Oxygen saturation below 90%, scores 1 point if present.
Clinical example
Case
Man, 58 years old, confirmed PE (segmental defect on the right). No cancer, no chronic cardiac or pulmonary disease. HR 88, BP 132/80, SaO2 96% on room air, alert.
Low risk (~1% mortality). Candidate for outpatient management with direct oral anticoagulants (apixaban, rivaroxaban) given reliable social support. Follow-up at 48-72 hours, then standard monitoring.
Limitations and cautions
Does not account for right ventricular dysfunction on echocardiography or biomarkers (troponin, BNP) — patients with sPESI = 0 and a positive troponin may still be at increased risk.
High sensitivity for excluding high risk (~93%), but low specificity — most patients score ≥ 1 point and are formally classified as high risk despite being clinically stable.
In patients aged 75-80 years the age criterion does not trigger, even though age is already clinically relevant — ESC recommends individualized assessment in this group.
Not validated in pregnancy or in cancer-associated PE during active chemotherapy.
Frequently asked questions
Does sPESI = 0 guarantee it is safe to send the patient home?
No, it does not guarantee safety, but it supports the case for outpatient treatment: combined with a negative troponin and normal RV function on echocardiography, it allows confident discharge on a DOAC.
What counts as "chronic heart or pulmonary disease"?
Heart failure with systolic or diastolic dysfunction, coronary artery disease, valvular disease, or paroxysmal atrial fibrillation with complications. On the pulmonary side: COPD (any stage), asthma with frequent exacerbations, pulmonary hypertension, or interstitial lung disease.
Why use sPESI instead of the full PESI?
Speed and simplicity of calculation (6 binary items instead of 11 weighted variables). Accuracy for distinguishing low from high risk is comparable, and sensitivity is slightly higher — 92.7% versus 90.2%.
Can sPESI be used in a patient with active cancer?
Yes, but the cancer criterion adds 1 point, placing the patient in the high-risk group. In cancer patients the standard is LMWH or a DOAC (edoxaban/apixaban preferred), with hospitalization decided on a case-by-case basis.
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Aleksandr A. Aulov
Physician, internal medicine, Sechenov School — independent medical education platform.
Calculators are compiled from the original publications and current clinical guidelines. Interpretation thresholds follow the source study unless stated otherwise.
This calculator is intended for healthcare professionals. Do not use it for self-diagnosis or self-treatment. Management decisions are made by the treating clinician based on the full clinical picture of the individual patient.
Last clinical review: April 28, 2026 ·
Author: Aleksandr A. Aulov,
MD, internal medicine ·
Primary source: Jiménez D et al. Arch Intern Med 2010; 170(15): 1381-1388