Pulmonary embolism severity index – Cardiology MCQ

100 Points on the pulmonary embolism severity index (PESI) would be classified as:
a) Class I
b) Class II
c) Class III
d) Class IV
Correct answer: c) Class III
Class III has a 3.1% 30 day mortality risk and has points in the range of 86-105 points. Class I with less than <65 points has virtually no 30 day mortality risk while Class V with over 125 points has 24.4% 30 day mortality risk.
Parameters considered for risk stratification are age, male gender, history of cancer, history of heart failure, history of chronic lung disease, pulse rate above 110/min, systolic blood pressure below 100 mm Hg, respiratory rate of 30 or more, body temperature below 36 degrees Centigrade, altered mental status and arterial oxyhaemoglobin saturation below 90%. Parameters have different weightages, with maximum of 60 for altered mental status and 30 each for history of cancer and hypotension. Tachypnea and hypothermia each have 20 points, while age gets one point per year so that above sixty years, age gets the highest weightage. Rest of the parameters get 10 points each.
Reference
1. Aujesky D et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 2005; 172 (8): 1041-46.