4-Level Pulmonary Embolism Clinical Probability Score (4PEPS) online calculator

4-level clinical probability score (4PEPS) is intended to help ED physicians make decisions regarding patients suspected of PE.

NB! The timing of vital sign values was not formally assessed by this study; clinician judgment to assess which vital sign should be used for the 4PEPS score.

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Surgery, lower limb plaster cast, or bedridden >3 days for acute medical condition within the last four weeks


$0
* Required
Age (years)<50-2
 50-64-1
  >640
SexFemale0
 Male+2
Chronic Respiratory DiseaseNo0
 Yes-1
Heart Rate <80No0
 Yes-1
Chest Pain AND Acute dyspnoeaNo0
 Yes+1
Current estrogen useNo0
 Yes+2
Prior History of VTENo0
 Yes+2
SyncopeNo0
 Yes+2
Immobility within the last four weeks Surgery, lower limb plaster cast, or bedridden >3 days for acute medical condition within the last four weeks  No0
 Yes+2
O2 saturation <95%No0
 Yes+3
Calf pain and/or unilateral lower limb edemaNo0
 Yes+3
PE is the most likely diagnosisNo0
 Yes+5

Interpretation:

4PEPS Score for PEClinical probability of PEPE diagnosis
<0Very low Clinical Pre-test Probability  (<2%)PE can be ruled out
0-5Low Clinical Pre-test Probability (2-20%)PE can be ruled out if D-dimer level <1.0 μg/mL
6-12Moderate Clinical Pre-test Probability (20-65%)PE can be ruled out if D-dimer level <0.5 μg/mL OR <(age x 0.01) μg/mL
≥13High Clinical Pre-test Probability (>65%)PE cannot be ruled out without imaging testing

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Literature:

  1. Roy P, Friou E, Germeau B, et al. Derivation and Validation of a 4-Level Clinical Pretest Probability Score for Suspected Pulmonary Embolism to Safely Decrease Imaging Testing. JAMA Cardiol. 2021;6(6):669–677. doi:10.1001/jamacardio.2021.0064
  2. Roy P, Friou E, Germeau B, et al. Derivation and Validation of a 4-Level Clinical Pretest Probability Score for Suspected Pulmonary Embolism to Safely Decrease Imaging Testing. JAMA Cardiol. 2021;6(6):669–677. doi:10.1001/jamacardio.2021.0064
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