Pulmonary embolism (PE) requires accurate risk assessment. We investigated the prognostic performance of the National Early Warning Score (NEWS) in emergency department patients with PE.We included patients = 18 years from our PE registry (2017 to 2021), excluding patients after cardiac arrest or intubation before admission. The primary outcome was a composite of 30-day all-cause mortality or the need for advanced therapy (i.e., systemic or catheter-directed thrombolysis). We used logistic regression and the Cox proportional hazards models to estimate associations. The Pulmonary Embolism Severity Index (PESI) and the European Society of Cardiology (ESC) classification served as covariates. The overall score performances were quantified using receiver operating characteristic analysis.We included 524 patients. Each increase in NEWS points increased the odds of the primary outcome by 69% (odds ratio: 1.69, 95% confidence interval [CI]: 1.51-1.89, p < 0.001) and 30-day mortality by 44% (hazard ratio: 1.44, 95% CI: 1.30-1.60, p < 0.001). Within the ESC intermediate-high and high-risk group, the 30-day mortality rate was higher in patients with a NEWS = 7 compared with NEWS < 7 (24 vs. 1%, p < 0.001). With a NEWS = 7, 30-day mortality was lower in patients who received advanced therapy (18 vs. 39%) but not significantly. The NEWS predicted the primary outcome better than the PESI (area under the curve: 0.853 vs. 0.752, p < 0.001).The NEWS was associated with 30-day mortality and the need for advanced therapy. Incorporating the NEWS into the ESC classification could help to assess patient outcomes early and thus support timely treatment decisions.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
Interesting idea to use the NEWS prediction rule (which was not designed to evaluate only patients with PE) to risk-stratify patients with confirmed pulmonary embolism. Perhaps the most newsworthy (no pun intended) finding here is that there was a suggestion (albeit not 'statistically significant') that NEWS may be able to identify patients most likely to derive a net benefit from thrombolysis (something that has been very difficult to achieve up to now). Hypothesis only at this point but possibly worth future prospective study.
, McMaster University