_id

683a1648c782e11e38d1b304

id

10370

title

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

full_title

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

short_title

4PEPS Score for PE

med_description

Rules out PE based on clinical criteria.

short_description

Rules out PE.

slug

4-level-pulmonary-embolism-clinical-probability-score-4peps

description

The 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS) rules out PE based on clinical criteria.

keywords

4-Level Pulmonary Embolism Clinical Probability Score (4PEPS), 4PEPS Score for PE, 4PEPS, PE, pulmonary embolism, PERC rule, DVT, Age-Adjusted D-Dimer, YEARS

complaint

[ "Chest Pain", "Cough", "Shortness of Breath" ]

formula

Addition of the selected points: *Surgery, lower limb plaster cast, or bedridden >3 days for acute medical condition within the last four weeks.

evidence

measurements

[ { "name": "Age", "unit": "age_adult", "error_min": "18", "error_max": "110", "warn_min": "18", "warn_max": "110", "conversion": "1", "normal_max_si": "0", "normal_max_us": "0", "normal_min_si": "0", "normal_min_us": "0", "units_si": "years", "units_us": "years" } ]

information

Interpretation:

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://jamanetwork.com/journals/jamacardiology/fullarticle/2776853", "text": "Roy P-M, 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. Published online March 3, 2021." } ], "Other References": [], "Outcomes": [], "Validation": [ { "href": "https://jamanetwork.com/journals/jamacardiology/fullarticle/2776853", "text": "Roy P-M, 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. Published online March 3, 2021." } ], "Validations": [] }

pearls

• Does rely on a subjective component (i.e., “PE is the most likely diagnosis”), which can lead to some scoring variability between clinicians.
• Studies have demonstrated an efficiency in correctly identifying PE cases ranging from 54%-68%, with a failure rate of 0.71%-1.3%.

usecase

• Utilize in patients presenting with signs and symptoms suggestive of pulmonary embolism (PE).
• Apply before ordering diagnostic imaging to categorize patients into different risk levels.

reasons

Provides a structured approach to estimate the probability of PE, reducing reliance on clinical judgment alone. Helps minimize unnecessary CT pulmonary angiography (CTPA) in low- and moderate-risk cases, reducing costs and patient exposure to radiation and contrast agents. In very low-risk patients, D-dimer testing may be avoided altogether, unlike with other similar tools.

next_advice

The results of this tool should not replace clinical judgment; always consider individual patient context and atypical presentations.

next_actions

next_management

Suggested management based on clinical probability results:

• Very low (<0): PE can be ruled out based on clinical criteria without further testing.
• Low (0-5): Check a d-dimer level. If <1.0 μg/mL, PE can be ruled out. Otherwise, proceed to imaging.
• Moderate (6-12): Check a d-dimer level. If <0.5 μg/mL OR <(age x 0.01) μg/mL, PE can be ruled out. Otherwise, proceed to imaging.
• High (≥13): Proceed to imaging.

diseases

[ "Deep Venous Thrombosis", "Pulmonary Embolism" ]

input_schema

[ { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "Age", "name": "age", "optional": false, "tips_en": "", "type": "textbox", "unit": "age_adult" }, { "conditionality": "", "default": null, "label_en": "Sex", "md_calc_info_concept": null, "name": "sex", "option_fhir_rules": null, "optional": false, "options": [ { "label": "Female", "value": 0 }, { "label": "Male", "value": 2 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": null, "label_en": "Chronic respiratory disease", "md_calc_info_concept": null, "name": "resp", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": -1 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": null, "label_en": "Heart rate <80", "md_calc_info_concept": null, "name": "bpm", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": -1 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": null, "label_en": "Chest pain AND acute dyspnea", "md_calc_info_concept": null, "name": "chest", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": null, "label_en": "Current estrogen use", "md_calc_info_concept": null, "name": "estrogen", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 2 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": null, "label_en": "Prior history of <abbr title=\"Venous thromboembolism\">VTE</abbr>", "md_calc_info_concept": null, "name": "vte", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 2 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": null, "label_en": "Syncope", "md_calc_info_concept": null, "name": "sync", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 2 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": null, "label_en": "Immobility within the last four weeks", "md_calc_info_concept": null, "name": "imm", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 2 } ], "show_points": true, "tips_en": "Surgery, lower limb plaster cast, or bedridden >3 days for acute medical condition within the last four weeks", "type": "toggle" }, { "conditionality": "", "default": null, "label_en": "O₂ saturation <95%", "md_calc_info_concept": null, "name": "pulse", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 3 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": null, "label_en": "Calf pain and/or unilateral lower limb edema", "md_calc_info_concept": null, "name": "calf", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 3 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": null, "label_en": "<abbr title=\"Pulmonary embolism\">PE</abbr> is the most likely diagnosis", "md_calc_info_concept": null, "name": "pediag", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 5 } ], "show_points": true, "tips_en": "", "type": "toggle" } ]

instructions

The timing of vital sign values were not formally assessed by this study; we recommend using clinician judgment to assess which vital sign should be used for the 4PEPS score.

published

2022-04-21T20:28:50.793Z

purpose

[ "Diagnosis", "Rule Out" ]

search_terms

[ "4-Level Pulmonary Embolism Clinical Probability Score (4PEPS), 4PEPS Score for PE, 4PEPS, PE, pulmonary embolism, DVT" ]

seo

{ "keywords_en": "4-Level Pulmonary Embolism Clinical Probability Score (4PEPS), 4PEPS Score for PE, 4PEPS, PE, pulmonary embolism, PERC rule, DVT, Age-Adjusted D-Dimer, YEARS ", "meta_description_en": "The 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS) rules out PE based on clinical criteria." }

specialty

[ "Cardiology", "Critical Care", "Emergency Medicine", "Family Practice", "Hospitalist Medicine", "Internal Medicine", "Primary Care", "Pulmonology" ]

departments

[ "Cardiac", "Respiratory" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 1750, "short_title_en": "Geneva Score (Revised)", "slug": "geneva-score-revised-pulmonary-embolism" }, { "calcId": 10343, "short_title_en": "Altitude-Adjusted PERC Rule", "slug": "altitude-adjusted-perc-rule" }, { "calcId": 347, "short_title_en": "PERC Rule", "slug": "perc-rule-pulmonary-embolism" } ]

ismed

false

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "cardiology", "pulmonology" ]

cleaned_use

[ "Utilize in patients presenting with signs and symptoms suggestive of pulmonary embolism (PE).", "Apply before ordering diagnostic imaging to categorize patients into different risk levels." ]

pub

false