MAGENT

sPESI score: the six items and how they add up

The simplified Pulmonary Embolism Severity Index (sPESI) adds one point for each of six items in a person already diagnosed with acute pulmonary embolism: age over 80, cancer, chronic cardiopulmonary disease, heart rate of 110 or more, systolic blood pressure below 100 mm Hg, and oxygen saturation below 90%. The total runs from 0 to 6. An 81-year-old with no other items scores 1; an 80-year-old scores 0.

This page doesn't give a cutoff. Magent's calculator also returns a low/high group, but this page explains how the total is built, not what a total means or what to do with it.

Not a medical device. Not a diagnosis or dosing recommendation.

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What is the sPESI score?

sPESI is a shortened version of the Pulmonary Embolism Severity Index (PESI), published by David Jiménez, Drahomir Aujesky, Lisa Moores and colleagues in the Archives of Internal Medicine in 2010. It's also searched as the simplified PESI or the sPESI calculator.

The 2010 abstract explains the starting point: "The Pulmonary Embolism Severity Index (PESI) estimates the risk of 30-day mortality in patients with acute pulmonary embolism (PE). We constructed a simplified version of the PESI."

This page explains each item and how the total is built. It doesn't say what any total means, and sPESI doesn't diagnose pulmonary embolism; it's for people in whom PE has already been diagnosed.

The sPESI formula

sPESI = (age > 80 ? 1 : 0)
      + cancer
      + chronic_cardiopulmonary_disease
      + (heart_rate_bpm >= 110 ? 1 : 0)
      + (systolic_mm_hg < 100 ? 1 : 0)
      + (spo2_percent < 90 ? 1 : 0)

Exact expression the calculator uses:

sPESI = age_gt_80 + cancer + chronic_cardiopulmonary_disease + heart_rate_ge_110 + systolic_mm_hg_lt_100 + spo2_lt_90; each 1 if present; max 6; 0 low, >=1 high

Each item is worth 1 point. Maximum: 6.

The six items

ItemInputScores 1 whenDoesn't score
Ageage, years (18–120)over 8080
Cancercancer (true/false)truefalse
Chronic cardiopulmonary diseasechronic_cardiopulmonary_disease (true/false)truefalse
Heart rateheart_rate_bpm (30–220)110 or more109
Systolic blood pressuresystolic_mm_hg (50–250)under 100100
Oxygen saturationspo2_percent (50–100)under 9090

How to calculate sPESI

  1. Age. Over 80 scores 1. Exactly 80 doesn't.
  2. Cancer. Active cancer, as assigned by the caller, scores 1.
  3. Chronic cardiopulmonary disease. One combined item: heart failure and chronic lung disease count together, once.
  4. Heart rate. 110 beats per minute or more scores 1. 109 doesn't.
  5. Systolic blood pressure. Under 100 mm Hg scores 1. Exactly 100 doesn't.
  6. Oxygen saturation. Under 90% scores 1. Exactly 90 doesn't; 89.9 does.
  7. Add the six. The total is 0 to 6.

Watch the directions. Age, systolic pressure and saturation are strict ("over 80," "under 100," "under 90"). Heart rate includes its edge ("110 or more").

Why heart failure and lung disease are one item

Magent's record notes that heart failure and chronic lung disease were combined in Jiménez 2010 into a single chronic cardiopulmonary disease item, so having both still scores 1. The abstract lists "chronic cardiopulmonary disease" as one of the six variables.

What the calculator returns

Magent's calculator returns the total, the maximum of 6, the age it used, a line for each item and a low/high group. This page doesn't interpret the group.

Worked examples

These use Magent's own expected values for the calculator. Unless stated, age is 70, heart rate 80, systolic 120 mm Hg, saturation 96% and the two yes/no items are absent.

Example 1: nothing scores

  1. Age 70 → 0; cancer no → 0; cardiopulmonary disease no → 0.
  2. Heart rate 80 → 0; systolic 120 → 0; saturation 96 → 0.
  3. sPESI = 0 (of 6).

Example 2: age 80 vs 81

  1. Age 80 → 0: sPESI = 0.
  2. Age 81 → 1: sPESI = 1.

Example 3: heart rate 109 vs 110

  1. Heart rate 109 → 0: sPESI = 0.
  2. Heart rate 110 → 1: sPESI = 1.

Example 4: saturation 90 vs 89.9

  1. Saturation 90.0 → 0: sPESI = 0.
  2. Saturation 89.9 → 1: sPESI = 1.

Example 5: all six

  1. Age 81 → 1; cancer → 1; cardiopulmonary disease → 1.
  2. Heart rate 110 → 1; systolic 99 → 1; saturation 89.9 → 1.
  3. sPESI = 6.

sPESI reference values

These are Magent's expected values for the calculator. With age 70, no cancer, no chronic cardiopulmonary disease, heart rate 80, systolic blood pressure 120 and SpO2 96.0%, the score is 0. Age 80 still scores 0, and age 81 scores 1. Cancer scores 1, and so does chronic cardiopulmonary disease. Heart rate 109 scores 0 and 110 scores 1. Systolic pressure 100 scores 0 and 99 scores 1. SpO2 90.0% scores 0 and 89.9% scores 1. Age 81 with cancer, chronic cardiopulmonary disease, heart rate 110, systolic pressure 99 and SpO2 89.9% scores 6.

History of sPESI

The score comes from David Jiménez, Drahomir Aujesky, Lisa Moores and colleagues with the RIETE Investigators, Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism, Archives of Internal Medicine, 2010 (volume 170, issue 15, pages 1383–1389).

The abstract describes how it was built: "univariate logistic regression of the original 11 PESI variables led to the removal of variables that did not reach statistical significance and subsequently produced the simplified PESI that contained the variables of age, cancer, chronic cardiopulmonary disease, heart rate, systolic blood pressure, and oxyhemoglobin saturation levels."

It was developed "in a derivation cohort of Spanish outpatients" and then tested retrospectively in an independent multinational cohort of outpatients from the Registro Informatizado de la Enfermedad Tromboembólica (RIETE).

The abstract names the six variables but not the item lines (over 80, 110, under 100, under 90). Those come from Magent's record and code.

When it's used

Magent's record describes sPESI as applying to people with already diagnosed acute symptomatic pulmonary embolism, as in Jiménez 2010. The caller supplies all six items.

Where it's used

The score was derived in Spanish outpatients and tested in the multinational RIETE registry.

Who uses it

The paper was written by the RIETE Investigators and collaborators.

Limits of the calculation

  • It adds six items. It doesn't diagnose PE and assumes PE has already been diagnosed.
  • It's sPESI, not the original PESI. It doesn't produce the original PESI classes.
  • Age over 80 is strict: 80 doesn't score.
  • Heart failure and chronic lung disease are one combined item.
  • The calculator returns a group alongside the total. This page doesn't give a cutoff or say what any total means.

Clinical decisions belong to a qualified clinician who knows the patient.

  • PERC rule is an eight-criterion block rule applied when PE is suspected, not after it's diagnosed.
  • Wells PE is a points score for the probability of PE before it's confirmed.

Glossary

  • PE: pulmonary embolism, a blood clot in the lung arteries.
  • PESI: the original Pulmonary Embolism Severity Index, with 11 variables.
  • Cardiopulmonary: relating to the heart and lungs.
  • Oxyhemoglobin saturation (SpO2): the share of hemoglobin carrying oxygen.
  • RIETE: Registro Informatizado de la Enfermedad Tromboembólica, a multinational registry of venous thromboembolism.

Common mistakes

  • Scoring age 80. It has to be over 80.
  • Scoring heart failure and lung disease separately. In sPESI they're one item.
  • Missing the heart-rate edge. 110 scores; 109 doesn't.
  • Scoring a systolic of 100. It has to be under 100.
  • Confusing sPESI with PESI. PESI has 11 variables and different classes.

Source

Jiménez D, Aujesky D, Moores L, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010;170(15):1383-1389. DOI: 10.1001/archinternmed.2010.199

Frequently asked questions

How do you calculate sPESI?

Add one point each for age over 80, cancer, chronic cardiopulmonary disease, heart rate 110 or more, systolic blood pressure under 100 mm Hg, and oxygen saturation under 90%. The total is 0 to 6.

What sPESI score is low risk?

This page doesn't give a cutoff. It shows how the total is built.

What's the difference between PESI and sPESI?

PESI uses 11 variables. sPESI keeps six of them, as one point each, with heart failure and chronic lung disease combined.

Does age 80 score in sPESI?

No. The item is age over 80.

Who developed sPESI?

David Jiménez and colleagues, in a 2010 paper in the Archives of Internal Medicine.