score_4peps: 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS)

In cliot: Clinical Indices and Outcomes Tools

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

Description

Calculates the 4PEPS score to stratify the clinical probability of pulmonary embolism (PE). This scoring system integrates clinical variables to assign patients into one of four risk categories (Very Low, Low, Moderate, High), each with a specific diagnostic strategy involving D-dimer testing cutoffs or imaging.

Usage

score_4peps(age, sex, chronic_resp_disease, heart_rate_lt_80,
            chest_pain_and_dyspnea, estrogen_use, history_vte,
            syncope, immobility_4wks, o2_sat_lt_95,
            calf_pain_unilateral_edema, pe_most_likely)

Arguments

age	Numeric. Patient age in years. (<50 years = -2 points; 50-64 years = -1 point; >=65 years = 0 points).
sex	String. Patient sex ("Male" or "Female"). (Male = +2 points; Female = 0 points).
chronic_resp_disease	Numeric (0 or 1). History of chronic respiratory disease. (Yes = -1 point).
heart_rate_lt_80	Numeric (0 or 1). Heart rate < 80 bpm. (Yes = -1 point).
chest_pain_and_dyspnea	Numeric (0 or 1). Presence of BOTH chest pain AND acute dyspnea. (Yes = +1 point).
estrogen_use	Numeric (0 or 1). Current estrogen use (contraception or replacement). (Yes = +2 points).
history_vte	Numeric (0 or 1). Prior history of VTE (DVT or PE). (Yes = +2 points).
syncope	Numeric (0 or 1). History of syncope related to current event. (Yes = +2 points).
immobility_4wks	Numeric (0 or 1). Immobility (bedridden >3 days, surgery, or lower limb cast) within the last 4 weeks. (Yes = +2 points).
o2_sat_lt_95	Numeric (0 or 1). O2 saturation < 95% on room air. (Yes = +3 points).
calf_pain_unilateral_edema	Numeric (0 or 1). Calf pain and/or unilateral lower limb edema. (Yes = +3 points).
pe_most_likely	Numeric (0 or 1). Pulmonary Embolism is the most likely diagnosis. (Yes = +5 points).

Value

A list containing:

Score	Total 4PEPS score.
Risk_Category	Clinical probability category (Very Low, Low, Moderate, High).
Management_Strategy	Recommended diagnostic action (e.g., rule out without testing, specific D-dimer cutoff, or imaging).

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(6):669-677. doi:10.1001/jamacardio.2021.0064

Examples

# Example 1: Very Low Risk
# 35yo Female (-2), HR < 80 (-1), No other risks -> Score -3
score_4peps(35, "female", 0, 1, 0, 0, 0, 0, 0, 0, 0, 0)

# Example 2: Moderate Risk
# 55yo Male (-1 + 2), Chest Pain/Dyspnea (+1), PE Most Likely (+5) -> Score 7
score_4peps(55, "male", 0, 0, 1, 0, 0, 0, 0, 0, 0, 1)

# Example 3: High Risk
# 70yo Female (0), Immobility (+2), O2 <95% (+3),
#Unilateral Edema (+3), PE Most Likely (+5) -> Score 13
score_4peps(70, "female", 0, 0, 0, 0, 0, 0, 1, 1, 1, 1)

cliot documentation built on Dec. 1, 2025, 1:06 a.m.