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Hestia Criteria

The Hestia criteria are 11 yes/no questions that help decide whether a patient with an acute pulmonary embolism (a blood clot in the lungs) can be treated at home. Any yes answer means hospital treatment. Zondag and colleagues published them in 2011. This tool is written for clinicians and is not a diagnosis.

Last reviewed: By the uncovermyrisk.com editorial team Educational only, not medical advice.

Sudden shortness of breath, chest pain, coughing up blood or fainting: call 911 now.General safety advice (not part of the published criteria). The criteria are for patients already diagnosed and being assessed; they do not replace urgent care.

Patient findings

Tick each question answered yes. Nothing you enter leaves this page.

Do the criteria apply?
Hestia questions (tick if yes)
Result appears here

What you will see

Whether any Hestia criterion is present, and which ones.

Educational only, not medical advice. Not a diagnosis. Treatment decisions belong to the treating team.

Source

Zondag W and colleagues, Journal of Thrombosis and Haemostasis 2011 (the Hestia Study). The 11 questions are taken from the open-access (CC BY) Table 5 of Brikho and colleagues, Cureus 2022. The tests check each question and that the criteria only apply with a confirmed pulmonary embolism.

Validated in

Patients with a confirmed acute pulmonary embolism who are being considered for outpatient treatment (Brikho 2022).

Limits

A result with no criterion present does not guarantee a safe course at home. In a pooled analysis for 30-day mortality, about 5 in 1,000 patients at higher risk would be misclassified as low risk by the Hestia criteria (Palas 2022). Several questions, such as a social reason for admission, rely on clinical judgement.

The criteria

For a patient with acute pulmonary embolism, answer each question yes or no (Brikho 2022):

  1. Is the patient hemodynamically unstable?
  2. Is thrombolysis or embolectomy necessary?
  3. Active bleeding or high risk of bleeding?
  4. More than 24 hours of oxygen needed to keep oxygen saturation above 90%?
  5. Was the pulmonary embolism diagnosed during anticoagulant treatment?
  6. Severe pain needing intravenous pain medication for more than 24 hours?
  7. Medical or social reason for treatment in hospital for more than 24 hours?
  8. Creatinine clearance below 30 mL/min?
  9. Severe liver impairment?
  10. Is the patient pregnant?
  11. History of heparin-induced thrombocytopenia?

If the answer to any one question is yes, the patient cannot be treated at home according to the Hestia Study (Brikho 2022). The criteria were published by Zondag and colleagues (Zondag 2011).

Worked example: a patient with a confirmed pulmonary embolism who is stable, needs no oxygen, has normal kidney and liver function, no bleeding risk, is not pregnant and has someone at home answers no to all 11 questions, so the criteria allow home treatment. If the same patient needed oxygen for more than 24 hours, the criteria would call for hospital treatment.

What the studies found

A meta-analysis of 3 studies that applied both the Hestia criteria and the simplified PESI found, for 30-day mortality, a sensitivity of 92.3% and a specificity of 33.8% for the Hestia criteria. The negative predictive values of both tools were above 97.7% (Palas 2022).

In 709 outpatients diagnosed with pulmonary embolism at a university hospital in Vienna, 156 (22%) were sent home for treatment. Of the low-risk patients treated at home, 89.7% had no Hestia criterion present. No low-risk patient died within 30 days (Nopp 2024).

Related calculators

For a points-based severity score, see the PESI score calculator. Before the diagnosis, see the Wells score for PE and the PERC rule calculator. Other bedside scores are listed under For healthcare professionals.

Sources

  1. Brikho S, Zughaib MT, Tsaloff G, Smythe K, Zughaib ME. Evaluating the Appropriateness of Pulmonary Embolism Admissions in a Community Hospital Emergency Department. Cureus. 2022;14(4):e24292. doi:10.7759/cureus.24292. PMID 35602808. Open access (CC BY). Table 5: the 11 Hestia questions; any yes means no home treatment in the Hestia Study. pmc.ncbi.nlm.nih.gov/articles/PMC9119667/
  2. Palas M, Silva BV, Jorge C, et al. The Accuracy of Hestia and Simplified PESI to Predict the Prognosis in Pulmonary Embolism: Systematic Review with Meta-analysis. TH Open. 2022;6(4):e347-e353. doi:10.1055/a-1942-2526. PMID 36452203. Open access (CC BY 4.0). 3 studies; Hestia mortality sensitivity 0.923, specificity 0.338; NPV above 0.977; 5 per 1,000 misclassified. pmc.ncbi.nlm.nih.gov/articles/PMC9593482/
  3. Nopp S, Bohnert J, Mayr T, et al. Early discharge and home treatment of patients with acute pulmonary embolism in the tertiary care setting. Intern Emerg Med. 2024;19(1):191-199. doi:10.1007/s11739-023-03415-4. PMID 37670173. Open access (CC BY 4.0). 709 outpatients, 156 (22%) home treatment; 89.7% of low-risk home-treated patients had no Hestia criterion; no low-risk deaths at 30 days. pmc.ncbi.nlm.nih.gov/articles/PMC10827840/
  4. Zondag W, Mos IC, Creemers-Schild D, et al. Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study. J Thromb Haemost. 2011;9(8):1500-1507. PMID 21645235. Original paper (cited; the criteria used here are taken from Brikho 2022, CC BY). pubmed.ncbi.nlm.nih.gov/21645235/

Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-02. Spotted an error? See About.