Key result
Novel ECG score outperforms Wells score for diagnosing acute pulmonary embolism with ~0.80 AUC.
Why the study?
The diagnostic performance of the novel electrocardiographic score (nECGs) for acute pulmonary embolism in Vietnamese patients was limited and needed evaluation.
Does a novel electrocardiographic score (nECGs) improve diagnostic accuracy for acute pulmonary embolism compared to the Wells score and D-dimer thresholds in adult patients with suspected PE?
Cohort (n=110)
Blinded (Outcome assessors)
No
Does a novel electrocardiographic score (nECGs) improve diagnostic accuracy for acute pulmonary embolism compared to the Wells score and D-dimer thresholds in adult patients with suspected PE?
Effect estimate: AUC 0.798 (95% CI 0.711-0.868)
Absolute Event Rate: 0.798% vs 0.701%
p-value: p=<0.001
A novel ECG scoring system (nECGs) offers superior diagnostic discrimination for acute pulmonary embolism compared to conventional Wells scoring and D-dimer testing in a tertiary-care cohort, proving particularly useful when D-dimer specificity is reduced by age and comorbidities.
nECGs may aid acute PE diagnosis over Wells and D-dimer; hypothesis-generating and requires multicenter validation before practice change.
Objective: The novel electrocardiographic score (nECGs) may provide complementary diagnostic information for acute pulmonary embolism (PE), but evidence in Vietnamese patients remains limited.Objectives: To evaluate the diagnostic performance of nECGs compared with the Wells score and D-dimer thresholds for the detection of acute PE.Methods: This prospective single-center diagnostic accuracy study included 110 consecutive adult patients with suspected PE who underwent standard 12-lead ECG, right-sided ECG, and computed tomography pulmonary angiography (CTPA).Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis.CTPA served as the reference standard.Results: Acute PE was confirmed in 56/110 patients (50.9%; median age 70.5 years).The nECGs demonstrated a significantly higher AUC (0.798; 95% CI, 0.711-0.868)than the Wells score ≥ 4 (0.701; 95% CI, 0.68206-0.785)and age-adjusted D-dimer (0.593; 95% CI, 0.495-0.68286)(p<0.001).nECGs achieved 91.1% sensitivity and 68.5% specificity.Fixed D-dimer (> 500 ng/mL) showed 100% sensitivity but only 9.3% specificity.Among 61 CTPA-selected patients with a Wells score ≤2, 20 (32.8%) had confirmed PE.In this subgroup, nECGs showed good discriminatory power (AUC 0.828) with a LR+ of 3.6829 and an LR-of 0.13.Combining nECGs with age-adjusted D-dimer increased LR+ to 4.36, while discrimination remained similar (AUC, 0.827). Conclusions:The nECGs provides good diagnostic discrimination for acute PE in this selected tertiary-care population and retained its performance among CTPA-selected patients with a Wells score <2.It may provide complementary bedside information within established PE diagnostic pathways.External validation in larger, lower-prevalence populations is warranted.
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Pham et al. (2026) conducted a cohort in Acute pulmonary embolism (n=110). Novel electrocardiographic score (nECGs) vs. Wells score and D-dimer thresholds was evaluated on Diagnostic accuracy for acute pulmonary embolism assessed by area under the receiver operating characteristic curve (AUC) (AUC 0.798, 95% CI 0.711-0.868, p=<0.001). The novel electrocardiographic score (nECGs) demonstrated significantly higher diagnostic discrimination for acute pulmonary embolism (AUC 0.798) compared to the Wells score ≥ 4 (AUC 0.701) and age-adjusted D-dimer (AUC 0.593).
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