Comparative Utility of Original and Simplified Pulmonary Embolism Severity Indices in Risk Stratification at a Tertiary Care Center

Abstract

Background: Pulmonary embolism (PE) is a potentially life-threatening condition requiring timely risk stratification to guide management. The pulmonary embolism severity index (PESI) and its simplified version (s-PESI) are widely used tools for prognostication. Objective: To evaluate the utility of the Pulmonary Embolism Severity Index (PESI) and its simplified version (s-PESI) in assessing patients with pulmonary embolism (PE) admitted to a tertiary care hospital. Methodology: A retrospective cohort study was conducted between January to December 2023, including 245 adult patients diagnosed with acute PE. Demographic data, clinical presentation, radiological findings, PESI and s-PESI scores, and outcomes including mortality, ICU admission, and length of hospital stay were analyzed. Survival outcomes were assessed using Kaplan-Meier analysis, and predictors of mortality were identified via Cox regression. Results: The mean age was 58.2±14.6 years, with 61.2% female patients. High-risk PESI scores (Class IV–V) were observed in 38.8% of patients, while s-PESI ≥1 was present in 72.2%. ICU admission occurred in 28.6% of patients, and in-hospital mortality was 11.4%. Both PESI and s-PESI scores were significantly associated with mortality (p<0.001). In multivariate analysis, PESI Class V (HR: 3.21, p=0.002) and s-PESI ≥2 (HR: 2.67, p=0.009) were independent predictors of poor outcome. Conclusion: Both PESI and s-PESI scores are valuable tools for risk stratification in PE. However, PESI demonstrated slightly superior prognostic accuracy in identifying patients at risk of adverse outcomes. These findings support the continued use of severity indices in guiding clinical decisions and resource allocation.