Pulmonary embolism
4PEPS
4-Level Pulmonary Embolism Clinical Probability Score (Roy 2021). Thirteen weighted items give one of four probability levels, each with its own D-dimer strategy: very low → PE ruled out without D-dimer; low → D-dimer < 1000 µg/L; moderate → D-dimer below the age-adjusted cut-off; high → imaging without D-dimer. In the derivation and validation cohorts it reduced imaging by about 22% with a failure rate below 2%.
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Age
Additional criteria
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- Not validated in pregnancy, in haemodynamically unstable patients or in patients already on anticoagulation.
Total score
0
Low clinical probability
Expected PE prevalence 2–20%
Decision guide
D-dimer: < 1000 µg/L (FEU) → PE ruled out. ≥ 1000 → CTPA.
1 section is still unanswered — counted as 0 points.
Ranges: -4–-1 Very low clinical probability0–5 Low clinical probability6–12 Moderate clinical probability13–22 High clinical probability
References
- Roy PM, 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;6:669-677.
- Konstantinides SV, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. Eur Heart J 2020;41:543-603.
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