Risk stratification in pulmonary embolism: current evidence and future directions

Pulmonary embolism (PE) is associated with high cardiovascular morbidity and mortality. Timely diagnosis and accurate prognostication are extremely important for guiding patient management and treatment selection. Risk stratification and clinical scoring systems are crucial for rapid assessment, effective triage, and accurate outcome prediction. Traditional tools have demonstrated strong prognostic value, and the role of dynamic risk assessment is increasingly recognized. Pretest probability scores including the Wells clinical prediction rule and the revised Geneva score, act as first line assessments to determine the need for further diagnostic testing. The Hestia criteria, Pulmonary Embolism Severity Index (PESI) and simplified Pulmonary Embolism Severity Index (sPESI) help to identify patients appropriate for outpatient management. For hospitalized patients, several additional scoring systems, imaging findings, and biomarkers can be used for further risk stratification and treatment planning. The development of multidisciplinary pulmonary embolism response teams (PERTs) and the integration of hybrid predictive models are demonstrating a shift toward a multimodal approach to PE risk stratification. The objective of this review is to summarize current approaches to risk assessment in pulmonary embolism, evaluate existing and emerging prediction models, as well as discuss future directions aimed at improving individualized care in the management and treatment of pulmonary embolism.