Hestia criteria calculator — interpretation & sources

Q: Hestia or sPESI for outpatient PE treatment?

Both are accepted by ESC 2019. The HOME-PE trial showed similar safety, with Hestia allowing physicians to override for individual reasons.

Q: Is the Hestia rule a score?

No — it is a checklist. Any positive item means the patient is not eligible for home treatment under the original protocol.

Interpretation

Hestia negative — eligible for outpatient treatment per Hestia rule	No criterion present: in the Hestia study, such patients were treated at home (sent home within 24 h) with 2.0 % recurrent VTE at 3 months.
Hestia positive — not eligible per original rule	At least one criterion present: the original Hestia rule foresees in-hospital treatment. AWMF 2023 notes that some criteria (e.g. HIT history) matter less in the DOAC era.

What is the Hestia criteria?

The Hestia criteria are an eleven-item checklist that selects patients with confirmed PE for outpatient treatment. Zondag and colleagues tested them in 297 patients in 12 Dutch hospitals (J Thromb Haemost 2011): patients with no criterion were sent home within 24 hours, with 2.0 % recurrent VTE and no fatal PE at three months. The HOME-PE trial later found Hestia comparable to sPESI for triage.

When to use it

Confirmed acute PE in a stable patient when outpatient treatment or early discharge is considered.
As a pragmatic alternative to sPESI/PESI that includes social and practical factors.
Documenting why a patient was or was not treated at home.

When not to use it

Suspected PE that has not been confirmed.
High-risk (haemodynamically unstable) PE.
As a substitute for assessing RV function and troponin when the clinical picture suggests strain.

Clinical pearls and limitations

Applies to confirmed PE. Hestia is a checklist, not a score — one 'yes' is enough to exclude home treatment under the original rule. RV dysfunction and troponin are not part of it; ESC 2019 still asks for clinical judgement on those.
One 'yes' answer is enough to exclude outpatient treatment under the original rule.
Several items are left to clinical judgement (instability, liver impairment, social reasons).
Creatinine clearance is calculated with Cockcroft-Gault.
AWMF 2023 notes that some items, such as a history of HIT, matter less now that DOACs avoid heparin.

Frequently asked questions

What are the Hestia criteria?

Haemodynamic instability, need for thrombolysis or embolectomy, active bleeding or high bleeding risk, > 24 h of oxygen, PE under anticoagulation, > 24 h of IV analgesia, medical or social reason for admission, CrCl < 30 mL/min, severe liver impairment, pregnancy, and a history of HIT.

Hestia or sPESI for outpatient PE treatment?

Both are accepted by ESC 2019. The HOME-PE trial showed similar safety, with Hestia allowing physicians to override for individual reasons.

Is the Hestia rule a score?

No — it is a checklist. Any positive item means the patient is not eligible for home treatment under the original protocol.

Have a follow-up question?

Medelix answers clinical questions from current guidelines and studies — every statement with its source.

Ask Medelix about the Hestia criteria

For healthcare professionals and medical students. These tools support, and do not replace, clinical judgement. Always check results against the original source and your local protocols.

Hestia criteria