Background: Although the European Society of Cardiology (ESC) predicts mortality in acute pulmonary embolism (PE) it may overtriage the level of clinical monitoring needed. While the National Early Warning Score (NEWS) is used to triage level of care in many diseases, it is rarely reported in PE literature. Methods: In this retrospective, single centre, observational cohort study of consecutive adults with acute PE, between 2017-2020, we aim to assess the association between NEWS scores and the risk of hemodynamic (HD) deterioration or PE-related death in intermediate-high risk PE patients. The National Early Warning Score (NEWS) at admission and after 24hours were determined. A baseline NEWS of ≥5 or the maximum score of a single parameter were considered an indication of high risk of our primary outcome (hemodynamic deterioration and/or PE-related mortality). Results: ESC classified 99 of 318 patients with PE intermediate-high risk, 8 patients (8%) met the primary outcome. 52 (52%) patients had an elevated NEWS and 7 of these met the primary outcome (13%), while only 1 patient with a non-elevated NEWS (2.0%) met the primary outcome (Negative predictive value of 98% (95% CI 90-98%)). Sensitivity of elevated NEWS in patients with intermediate-high risk patients was 88% (95% CI 74-90%) and the specificity was 51% (95% CI 41-61%). Conclusions: Using NEWS in intermediate high risk, acute PE patients may improve accuracy in identifying patients with a higher risk of adverse outcomes and may guide the decision to monitor a patient in a high-care department, especially in patients with intermediate high risk PE.
Overgaauw et al. (Mon,) studied this question.