TRIAGE Scoring System: Advancing ECG-Based Early Detection of Acute Pulmonary Embolism

Background Acute pulmonary embolism (APE) as a common cardiopulmonary disease is associated with a high mortality rate. Therefore, its rapid and accurate diagnosis remains a medical challenge. The present study aimed at providing a new electrocardiogram (ECG) model for easy and rapid estimation of the probability of APE through ECG findings. Method This retrospective study was conducted on 319 patients suspected of APE that were admitted to Shahid Chamran and Al-Zahra Hospitals in Isfahan during 2017–2023. Patients’ demographic, clinical, and 16 ECG findings were extracted from their medical records. Other standard criteria such as Wells, Geneva, and Daniel were also calculated. Results In this study, an ECG-predictive model, called TRIAGE score, was proposed comprising three ECG findings including T achycardia, R ight bundle branch block (RBBB) (complete/incomplete), and I nverted T-wave in the right precordial leads (V1-V4) as well as basic patient characteristics such as A ge, G ender, and E dema. TRIAGE score at a higher cut-off point ≥ 3 with sensitivity of 80.77% and specificity of 50.31% and at a higher cut-off point ≥ 4 with sensitivity of 44.23% and specificity of 86.50% had a significant diagnostic value in predicting APE ( P value < 0.001). Moreover, TRIAGE score had significantly higher diagnostic value than other criteria including Wells, Geneva, Daniel, and d-dimer levels ( P value < 0.001). Conclusion The TRIAGE score, which integrates ECG findings (tachycardia, RBBB, and inverted T-waves in leads V1–V4) with patient characteristics (age, gender, edema), shows promising specificity in diagnosing APE. At a cut-off score of ≥4, it demonstrated statistically significant diagnostic performance compared to existing criteria such as Wells, Geneva, Daniel, and d-dimer levels. These findings suggest the TRIAGE score may serve as a useful adjunct in the early assessment of APE, particularly in settings where advanced imaging is not readily available.