4PEPS (4-level PE probability score)
4PEPS: a 13-item weighted clinical pretest-probability score for PE, ruling out at the very-low and low strata (Roy 2021).
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Age
- 70 years
- Male sex
- Yes
- Prior VTE
- Yes
- Syncope
- Yes
- Calf pain and/or unilateral lower-limb edema
- Yes
- PE is the most likely diagnosis
- Yes
Result: 4PEPS total +14: high clinical probability -- direct CT pulmonary angiography -- no D-dimer rule-out.
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Score
- 13 weighted items, total -5 to +21 (age, sex, chronic respiratory disease, HR < 80, chest pain + dyspnea, estrogen, prior VTE, syncope, immobility, SpO2 < 95%, calf pain/edema, PE most likely).
- Tiers
- < 0 very low (no test), 0-5 low (D-dimer < 1000 ng/mL, i.e. 1.0 μg/mL), 6-12 moderate (age-adjusted D-dimer), >= 13 high (direct imaging).
What you enter
- Age
- Heart rate
- Pulse-oximetry O2 saturation
- Male sex
- Chronic respiratory disease
- Chest pain AND acute dyspnea
- Hormonal estrogenic treatment
- Prior VTE (DVT or PE)
The other 4 fields
- Syncope
- Immobility or surgery within 4 weeks
- Calf pain and/or unilateral lower-limb edema
- PE is the most likely diagnosis
How this is calculated
Roy PM, 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. 2021;6(6):669-677. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.