ToolsCalculators
Hestia Criteria for Outpatient Pulmonary Embolism Treatment
Identifies patients with acute pulmonary embolism who can be safely managed as outpatients.
Hestia Criteria for Outpatient Pulmonary Embolism Treatment
Hemodynamically unstable
e.g. sustained hypotension, needing thrombolysis or vasopressors.
Thrombolysis or embolectomy required
Active bleeding or high risk of bleeding
Needs >24 hours of oxygen to keep SpO2 >90%
PE diagnosed while already on anticoagulant treatment
Severe pain requiring IV medication for >24 hours
Medical or social reason for hospital treatment >24 hours
e.g. concurrent infection, malignancy needing admission, no home support.
Creatinine clearance <30 mL/min
Severe hepatic impairment
Pregnancy
Documented history of heparin-induced thrombocytopenia (HIT)
ResultEligible for outpatient treatment
No Hestia criteria are present; outpatient management of acute PE can be considered.
- Criteria present
- 0
When to use
- Deciding whether a hemodynamically stable patient with confirmed acute PE can be treated as an outpatient.
- Alternative to the PESI/sPESI score for outpatient-eligibility triage.
Formula
Checklist of 11 exclusion criteria. If ANY criterion is present, the patient is not suitable for outpatient treatment; if ALL are absent, outpatient treatment can be considered.
Pearls and pitfalls
- Intended for patients who are already hemodynamically stable; it is a suitability checklist, not a mortality risk score.
- Validated prospectively as a stand-alone rule, and subsequently shown to perform well irrespective of right ventricular function on imaging.