Healthcare & Clinical Formulas
Hestia Criteria for Outpatient Pulmonary Embolism (PE) Disposition
Evaluate all 11 binary Hestia exclusion criteria (hemodynamics, thrombolysis, active bleeding, >24h oxygen, breakthrough PE, IV opioids, CrCl <30, severe liver disease, pregnancy, HIT, social support) to clear low-risk PE patients for direct home DOAC therapy.
Why ESC guidelines pair Hestia = 0 with sPESI = 0 for safe home PE treatment!
Whereas PESI and sPESI estimate 30-day physiological mortality, they do not ask practical bedside disposition questions like "Does this patient need IV morphine, supplemental oxygen, have CrCl < 30 mL/min, or live alone without phone access?" Wendy Zondag and the Hestia Study Group (Journal of Thrombosis and Haemostasis, 2011) validated an 11-item pragmatic checklist where a single "Yes" (1) mandates hospital admission, while "No" across ALL 11 items (Hestia = 0) identifies acute PE patients who can safely start direct oral anticoagulation (DOAC) at home (<2% recurrent VTE, <1% major bleeding)!
Because Hestia is a strict zero-tolerance rule-out checklist, spreadsheet calculators must validate that every single one of the 11 items is answered strictly 0 or 1 via SUMPRODUCT((B2:B12 <> 0) * (B2:B12 <> 1)) = 0 before clearing a patient for outpatient discharge!
| 11-Item Hestia Exclusion Count | Disposition Recommendation | Clinical Action Plan |
|---|---|---|
| 0 Positive Criteria (All 11 = 0) | Outpatient Home Treatment Eligible (Hestia = 0) | Direct DOAC + 24–72h Outpatient Follow-Up |
| 1 Positive Criterion (e.g., CrCl < 30 or O2 > 24h) | Inpatient Admission Required (Hestia >= 1) | Hospitalize for Monitoring & Adjusted Anticoagulation |
| Unanswered or Non-Binary Entry | "Invalid Binary Hestia Input" | All 11 Items Must Be Verified 0 or 1 |
Total Positive Hestia Exclusion Criteria Count (0–11)
Verifies every cell in B2:B12 holds strictly 0 or 1 and sums total exclusion triggers.
=IF(OR(COUNTA(B2:B12) < 11, SUMPRODUCT((B2:B12 <> 0) * (B2:B12 <> 1)) > 0), "Invalid Binary Hestia Input", SUM(B2:B12))Hestia Outpatient vs Inpatient PE Disposition Decision
Clears for home treatment strictly when all 11 items are verified 0; triggers hospital admission when SUM(B2:B12) >= 1.
=IF(OR(COUNTA(B2:B12) < 11, SUMPRODUCT((B2:B12 <> 0) * (B2:B12 <> 1)) > 0), "Invalid Binary Hestia Input", IF(SUM(B2:B12) = 0, "Outpatient Home Treatment Eligible (Hestia = 0)", "Inpatient Admission Required (Hestia >= 1)"))Try the example
Use the original values or change them to test your understanding.