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4-Level Pulmonary Embolism Clinical Probability Score (4PEPS)
Clinical pretest probability of PE to guide D-dimer and imaging.
4-Level Pulmonary Embolism Clinical Probability Score (4PEPS)
Age
Chronic respiratory disease
Heart rate < 80 /min
Chest pain AND acute dyspnea
Male sex
Current hormonal estrogenic treatment
Prior venous thromboembolism
Syncope
Immobility within the last 4 weeks
Oxygen saturation < 95%
Calf pain and/or unilateral lower-limb edema
PE is the most likely diagnosis
Result0 points
Low clinical probability. PE excluded if D-dimer < 1000 ng/mL.
- Probability level
- Low
When to use
- Estimating pretest probability of PE in outpatients/ED patients with suspected pulmonary embolism.
Formula
Sum weighted items (range about -4 to +21). <0 very low, 0-5 low, 6-12 moderate, >=13 high.
Pearls and pitfalls
- The graded D-dimer thresholds (none / 1000 ng/mL / age-adjusted) are what allow 4PEPS to reduce imaging.