What are simple mnemonics for the sPESI (simplified Pulmonary Embolism Severity Index) and PESI (Pulmonary Embolism Severity Index) scores in adults with suspected pulmonary embolism, particularly those with a history of previous thromboembolic events or underlying conditions such as cancer or heart disease?

Mnemonics for sPESI and PESI Scores

Simplified PESI (sPESI) Mnemonic: "CHAMPS"

The sPESI score uses 6 binary variables (1 point each), and you can remember them with "CHAMPS": 1, 2

• Cancer (active, diagnosed within 12 months or undergoing treatment) 1
• Heart rate ≥110 bpm 1, 2
• Age >80 years 1, 2
• Malfunction of cardiopulmonary system (chronic cardiopulmonary disease) 1, 2
• Pressure <100 mmHg systolic 1, 2
• Saturation <90% (arterial oxygen saturation, with or without supplemental oxygen) 1, 2

A score of 0 = low risk (30-day mortality 1.0-1.1%); ≥1 = high risk 1, 3

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Original PESI Mnemonic: "CHAMP SMART"

The original PESI is more complex with 11 weighted variables. Remember "CHAMP SMART": 4, 2

• Cancer (+30 points) 4
• Heart failure (+10 points) 4
• Age (actual age in years) 4, 2
• Male sex (+10 points) 4
• Pulse ≥110 bpm (+20 points) 4

Systolic BP <100 mmHg (+30 points) 4

• Mental status altered (+60 points) 4
• Arterial oxygen saturation <90% (+20 points) 4
• Respiratory rate >30 breaths/min (+20 points) 4
• Temperature <36°C (+20 points) 4

Plus chronic pulmonary disease (+10 points) 4

Risk Classes: Class I (≤65 points, 1.6% mortality), Class II (66-85 points, 3.5% mortality), Class III (86-105 points, 7.1% mortality), Class IV (106-125 points, 11.4% mortality), Class V (≥126 points, 23.9% mortality) 4, 2

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Clinical Application Pearls

The sPESI is preferred in clinical practice due to its simplicity while maintaining equivalent prognostic accuracy to the original PESI (both with area under the curve ~0.75-0.84). 1, 3

• Low-risk patients (PESI Class I/II or sPESI=0) are candidates for outpatient management with direct oral anticoagulants when exclusion criteria are absent 5, 6
• The sPESI classifies 30-36% of patients as low risk compared to 36-49% with original PESI, with both showing excellent negative predictive value for 30-day mortality 1, 3
• In cancer patients, these scores require additional validation, as the original derivation studies included limited numbers of oncology patients 7, 8
• The presence of right ventricular dysfunction on imaging or elevated cardiac biomarkers should prompt further risk stratification even in low PESI/sPESI patients, as these findings may warrant inpatient observation 2, 6