The European Society of Cardiology (ESC) proposed several algorithms for patients with suspected pulmonary embolism. One algorithm relates to predicting the risk of early mortality.
Patient selection: suspected PE
Parameters:
(1) shock or hypotension
(2) PESI or simplified PESI (sPESI)
(3) signs of right ventricular dysfunction on imaging study (echocardiography; CT angiography)
(4) elevation of serum troponin
Criteria for shock or hypotension:
(1) one of the following:
(1a) systolic blood pressure < 90 mm Hg for > 15 minutes
(1b) drop in systolic blood pressure >= 40 mm Hg for > 15 minutes
(2) exclusion of alternative explanation (new-onset arrhythmia, sepsis, hypovolemia)
|
Shock or Hypotension
|
PESI or sPESI
|
RV Dysfunction
|
Serum Troponin
|
Risk Group
|
|
yes
|
NA
|
NA
|
NA
|
high
|
|
no
|
>= III; >= 1
|
yes
|
yes
|
intermediate high
|
|
no
|
>= III; >= 1
|
yes
|
no
|
intermediate low
|
|
no
|
>= III; >= 1
|
no
|
yes
|
low intermediate
|
|
no
|
< III; 0
|
yes
|
no
|
intermediate low
|
|
no
|
< III; 0
|
no
|
yes
|
low intermediate
|
|
no
|
< III; 0
|
no
|
no
|
low intermediate
|
|
no
|
< III; 0
|
no
|
no
|
low
|
If the PESI < III or sPESI 0 then RV dysfunction and serum troponin are optional tests.
