respiratory emergency

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

Novel 4-level clinical probability score for pulmonary embolism that includes age and directly classifies patients into unlikely/low/intermediate/high PE probability. Developed by Roy et al. 2021 as an improvement over Wells and revised Geneva scores in the age of D-dimer adjustment. Designed to reduce unnecessary CTPA ordering. Validated in 1,746 patients.

Age (select age group)*

Previous PE or DVT*

Surgery or immobilisation within past 4 weeks*

Haemoptysis*

Active cancer (treated within 6 months or palliative)*

Unilateral leg pain AND clinical signs of DVT (tenderness, swelling, erythema)*

Heart rate above 80 bpm*

No alternative diagnosis more likely than PE*

References

Roy PM et al. 4PEPS: a new score for clinical probability assessment of pulmonary embolism. Eur Respir J. 2021;57(1):2003474.
ESC Task Force. 2019 ESC Guidelines for diagnosis and management of acute pulmonary embolism. Eur Heart J. 2020;41(4):543-603.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against MDCalc, NICE, or your local guideline before clinical use.

References

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