Download PDF
Open Access
CC BY-NC-ND 4.0 · Thromb Haemost
DOI: 10.1055/a-2544-3626
Stroke, Systemic or Venous Thromboembolism

Enhancing Pulmonary Embolism Risk Stratification: The National Early Warning Score and Its Integration into the European Society of Cardiology Classification

Authors

  • Karin Janata

    1   Department of Emergency Medicine, Medical University of Vienna, Wien, Austria

  • Alexandra Julia Lipa

    1   Department of Emergency Medicine, Medical University of Vienna, Wien, Austria

  • Anne Merrelaar 

    1   Department of Emergency Medicine, Medical University of Vienna, Wien, Austria

  • Marieke Merrelaar

    1   Department of Emergency Medicine, Medical University of Vienna, Wien, Austria

  • Ursula Azizi-Semrad

    1   Department of Emergency Medicine, Medical University of Vienna, Wien, Austria

  • Harald Herkner 

    1   Department of Emergency Medicine, Medical University of Vienna, Wien, Austria

  • Michael Schwameis 

    1   Department of Emergency Medicine, Medical University of Vienna, Wien, Austria

  • Juergen Grafeneder 

    1   Department of Emergency Medicine, Medical University of Vienna, Wien, Austria

Funding K.J. received funding from Boston Scientific. No funding was obtained for this study.
Further Information
  Permissions and Reprints


Graphical Abstract

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

pulmonary embolism - risk assessment - mortality - emergency medicine - thrombolytic therapy

Data Availability Statement

The article's data will be shared at a reasonable request by the corresponding author.


Authors' Contribution

K.J.: Conceptualization, data collection and supervision, writing—original draft preparation; A.J.L.: literature review, data collection, data validation; A.M.: data collection, data validation, manuscript review; M.M.: data collection, data validation, manuscript review; U.A.: clinical expertise, literature review, manuscript review; H.H.: methodology refinement, statistical analysis, data interpretation, manuscript review; M.S.: project supervision, data interpretation, critical evaluation, manuscript editing; J.G.: conceptualization, statistical analysis, data interpretation, manuscript writing—review and editing.


Supplementary Material



Publication History

Received: 26 August 2024

Accepted: 17 January 2025

Accepted Manuscript online:
24 February 2025

Article published online:
08 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany