Lit Matters 3: STAMP Score for PE Risk

Intermediate-high-risk pulmonary embolism can decompensate within 48 hours despite normal blood pressure at presentation. The STAMP score is a bedside risk tool for short-term PE deterioration that combines syncope, RV dysfunction, age, MAP, and chest pain into a simple early-stratification framework.

STAMP Score for Intermediate-High-Risk PE

• Early decompensation window: Intermediate-high-risk PE is not benign; about 10% deteriorate early, making the first 48 hours the key monitoring period for patients with RV strain and positive biomarkers.
• Five-item bedside model: STAMP uses five readily available variables: syncope, chest pain, age 65 or older, mean arterial pressure, and the TAPSE-to-PASP ratio as the echo marker of RV dysfunction.
• RV dysfunction signal: A TAPSE/PASP ratio of 0.33 or less identifies impaired RV-PA coupling and was one of the strongest predictors of short-term clinical worsening in this cohort.
• Risk tier separation: The low-risk STAMP group had 0% 48-hour deterioration in both derivation and validation cohorts, while adverse events clustered in the intermediate and high tiers.
• Validation performance: The validation cohort showed an AUC around 0.85, suggesting good discrimination for early PE decompensation. We get into what that does and does not justify in the chapter.
• Disposition uncertainty: STAMP may help frame ICU versus floor discussions in intermediate-high-risk PE, but the action thresholds and escalation decisions still need broader external validation.