cliot (version 1.0.0)

score_4peps: 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)

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).

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).

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)