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

Nataliia Lopina January 8, 2022

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.

Age (years)	<50	-2
	50-64	-1
	>64	0
Sex	Female	0
	Male	+2
Chronic Respiratory Disease	No	0
	Yes	-1
Heart Rate <80	No	0
	Yes	-1
Chest Pain AND Acute dyspnoea	No	0
	Yes	+1
Current estrogen use	No	0
	Yes	+2
Prior History of VTE	No	0
	Yes	+2
Syncope	No	0
	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	No	0
	Yes	+2
O₂ saturation <95%	No	0
	Yes	+3
Calf pain and/or unilateral lower limb edema	No	0
	Yes	+3
PE is the most likely diagnosis	No	0
	Yes	+5

Interpretation:

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

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Literature:

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
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