PE Triage Calculator — Reperfusion Triage for Pulmonary Embolism

What it does

A clinician-facing triage calculator designed to reduce unnecessary IR consults while safely flagging patients who are unstable or objectively deteriorating. It organizes PE risk features (hemodynamics, RV strain, biomarkers, and trajectory) into a clear recommendation card with escalation triggers.

It is intentionally conservative: the default is medical management unless instability or objective deterioration is present.

Why it matters

• IR consult volume can be driven by uncertainty, not by objective deterioration.
• “Intermediate-high risk” is not automatically a procedure indication — trajectory matters.
• Clear, shared escalation triggers reduce churn between teams and prevent delayed decompensation recognition.
• Documentation quality improves when the logic is explicit and the inputs are summarized cleanly.

Inputs it uses

• Setting (ED new diagnosis vs inpatient) with stability window (4–6h vs 24h)
• Hemodynamics: SBP now, lowest SBP, baseline SBP, sustained hypotension, CPR
• Pressors: none vs supportive vs required to maintain BP/MAP (shock physiology)
• Hypoperfusion markers (lactate trend, AMS, oliguria, cool/clammy)
• RV strain: RV/LV ratio and/or CT/echo RV dysfunction
• Biomarkers: troponin and BNP/NT-proBNP categories (values optional for summary only)
• Objective deterioration within stability window (oxygen escalation, SBP trend, tachycardia, rising lactate, ICU upgrade)
• Modifiers: symptom duration, clot location, thrombolysis contraindication, current O2 support

Output logic

The tool does two things first:

1. Detects hemodynamic instability (shock physiology or arrest) → immediate high-risk pathway.
2. Detects objective deterioration within the stability window → escalation pathway when intermediate-high features exist.

It then labels risk (ESC-style) as Low / Intermediate-low / Intermediate-high and chooses a recommendation card:

• Medical management (default) — Anticoagulation + close monitoring
• Watchlist: Pulmonary/PERT discussion — IR optional planning
• Deteriorating intermediate-high — Reperfusion considered (PERT + IR)
• High-risk (massive) — Emergency reperfusion pathway

Evidence (selected)

• STORM-PE (RCT, 2024): Intermediate-high risk population; physiologic improvement; no demonstrated mortality benefit; procedure risks exist.
• PEERLESS (RCT, 2024): Among patients selected for catheter intervention; mechanical thrombectomy outperformed catheter-directed thrombolysis on a composite driven by less deterioration/bailout and less ICU utilization; no difference in mortality or major bleeding.
• Guideline framing (ESC/ACC summaries): Systemic thrombolysis is reserved for high-risk hemodynamic instability; routine reperfusion is not recommended for stable intermediate-risk PE; catheter or surgical options considered for rescue when instability develops or when thrombolysis is contraindicated/failed.

Who it’s for

• ED and hospitalist teams who need clear escalation triggers
• Pulmonary/PERT teams standardizing triage language
• IR teams who want fewer low-yield consults and cleaner consult requests
• Trainees learning PE risk framing

Technical notes

Single-file HTML with embedded CSS and JavaScript. No external dependencies. No tracking. No backend calls. Runs in any modern browser.

Privacy / data handling

This calculator runs entirely client-side and does not store or transmit data. Do not enter patient identifiers. Use the “Copy summary” function only for de-identified clinical summaries.

Reviewed by Pouyan Golshani, MD, Interventional Radiologist — February 22, 2026